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General NPI Number Information
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NPI Number | 1235466855
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Entity Type | Organization
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Legal Business Name | ICAN & ASSOCIATES, INC.
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 6112 LOUISE ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-2719
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Country | US
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Telephone | 910-860-9787
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Fax | 910-860-3903
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Provider Business Mailing Address
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Address Line | PO BOX 25433
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5007
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Country | US
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Telephone | 910-860-3903
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/CEO
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Name | SHANNON M BATTLE
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Credential | MA
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Telephone | 910-860-9787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5518
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License Number State | NC
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