Provider Demographics
NPI:1225999683
Name:ICE, DEBORAH
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:ICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40935 FOXTAIL FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2264
Mailing Address - Country:US
Mailing Address - Phone:703-898-2775
Mailing Address - Fax:
Practice Address - Street 1:40935 FOXTAIL FIELDS DR
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-2264
Practice Address - Country:US
Practice Address - Phone:703-898-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000302103TC0700X
VA0810003620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical