Individual
GREGORY ICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1627 GRAFTON RD, MORGANTOWN, WV 26508
(304) 906-7791
Mailing address
1627 GRAFTON RD, MORGANTOWN, WV 26508
(304) 906-7791
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
DP02941720
WV
1041C0700X
Clinical Social Worker
SW10590
FL
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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