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General NPI Number Information
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NPI Number | 1801070339
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Entity Type | Organization
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Legal Business Name | I CAN AND ASSOCIATES
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 7237 GODFREY DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-2425
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Country | US
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Telephone | 910-860-9787
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Fax |
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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 | 910-860-9787
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHANNON MONIQUE BATTLE
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Credential | M.S
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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 | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL042055
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License Number State | NC
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