Provider Information for 1962265595
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TIMOTHY DWANE ICE LMFT
Sex: Male
NPI: 1962265595
Last Updated: 2024-02-05
Certification Date: 2024-02-05
Certification Date: 2024-02-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1962265595 | ||||||||
| Enumeration Date | 2024-02-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3313 GREENHAM DR CHESTER, VA 23831-7153 United States Phone: 910-366-1024 | Fax: | ||||||||
| Primary Practice Address | 3313 GREENHAM DR CHESTER, VA 23831-7153 United States Phone: 910-366-1024 | Fax: | ||||||||
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