Individual
CORRIE ANN TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 S 9TH ST, PHILADELPHIA, PA 19107-5125
(215) 592-4500
Mailing address
260 S. BROAD STREET, PHILA, PA 19102-5126
(215) 985-2500
(267) 765-2325
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW130684
PA
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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