Individual
CHRISTOPHER DANIEL ICENHOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1400 WILLOW LN, N WILKESBORO, NC 28659-3551
(336) 667-5151
Mailing address
284 EXECUTIVE PARK DR, STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C011464
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861824682
—
NC
01
—
19G4X
BCBS
NC
Enumeration date
08/02/2013
Last updated
07/10/2020
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