Provider Demographics
NPI:1235466855
Name:ICAN & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ICAN & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:910-860-9787
Mailing Address - Street 1:PO BOX 25433
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5007
Mailing Address - Country:US
Mailing Address - Phone:910-860-3903
Mailing Address - Fax:
Practice Address - Street 1:6112 LOUISE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2719
Practice Address - Country:US
Practice Address - Phone:910-860-9787
Practice Address - Fax:910-860-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5518101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNAMedicaid