Individual
MRS. JANE LEE ICKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
5251-37 JOHN TYLER HWY, PLT'S ABA WELLNESS CLINIC, WILLIAMSBURG, VA 23185
(757) 846-6959
Mailing address
5251-37 JOHN TYLER HWY, PLT'S ABA WELLNESS CLINIC, WILLIAMSBURG, VA 23185
(757) 846-6959
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904007677
VA
1041C0700X
Clinical Social Worker
C005652
NC
Other
Enumeration date
01/23/2007
Last updated
01/21/2015
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