Individual
ROBERT TICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6461 BRADSHAW RD, SALEM, VA 24153-2223
(540) 384-6748
Mailing address
6461 BRADSHAW RD, SALEM, VA 24153-2223
(540) 384-6748
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710103540
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0710103540
—
VA
Enumeration date
10/21/2021
Last updated
10/21/2021
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