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General NPI Number Information
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NPI Number | 1992073894
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Entity Type | Organization
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Legal Business Name | INNOVATIVE COMMUNITY ACTION NETWORK
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 1108 DELLWOOD DR STE A
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City | RICHWOOD
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State | LA
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Zip | 71202-6738
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Country | US
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Telephone | 318-280-6110
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7514
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City | MONROE
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State | LA
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Zip | 71211-7514
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Country | US
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Telephone | 318-280-6110
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CHRISTOPHER DEWAYNE HANDY
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Credential | PHD
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Telephone | 318-280-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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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 | 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 #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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