Organization
ICAN & ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON MONIQUE BATTLE M.S. (DIRECTOR)
(910) 860-9787
Entity
Organization
Contact information
Practice address
3002 BRINKLEY DR, SPRING LAKE, NC 28390-1602
(910) 860-9787
Mailing address
PO BOX 25433, FAYETTEVILLE, NC 28314-5007
(910) 860-9787
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL026750
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603441
—
NC
Enumeration date
12/19/2007
Last updated
12/19/2007
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