Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1699340463 |
---|---|
Provider Name | Wanda L Rice-Smith |
First Address | Brandon, MS 39043-0088 |
Second Address | Brandon, MS 39042-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2021 |
Last Update Date | 24/05/2021 |