Individual
TIMOTHY DWANE ICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
3313 GREENHAM DR, CHESTER, VA 23831-7153
(910) 366-1024
Mailing address
3313 GREENHAM DR, CHESTER, VA 23831-7153
(910) 366-1024
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
205379
TX
Other
Enumeration date
02/05/2024
Last updated
02/05/2024
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