Organization Name: | INNOVATIVE COMMUNITY ACTION NETWORK |
NPI Number: | 1992073894 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTOPHER DEWAYNE HANDY (EXECUTIVE DIRECTOR) |
Mailing Address: | 1108 Dellwood Dr Ste A Richwood |
State: | LA US |
Postal Code: | 712026738 |
Phone Number: | 3182806110 |
Fax Number: | |
NPI Enumeration Date: | 12/06/2011 |
NPI Last Update Date: | 12/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |