Provider Demographics
NPI:1447835814
Name:RICE, BROOKE ALEXANDRA (MSW, CMHT)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ALEXANDRA
Last Name:RICE
Suffix:
Gender:F
Credentials:MSW, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 MARQUETTE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3038
Mailing Address - Country:US
Mailing Address - Phone:601-421-3933
Mailing Address - Fax:
Practice Address - Street 1:101 N BRIGHTON DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3089
Practice Address - Country:US
Practice Address - Phone:601-421-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker