Active NPI
Christopher Daniel Icenhour, LCSW
- Clinical Social Worker
- N Wilkesboro, NC
National Provider Identifier
1861824682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C011464
- Practice address
- 1400 Willow LN
N Wilkesboro, NC 28659-3551 - Phone
- (336) 667-5151
- NPI assigned
- Aug 2, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C011464 | NC | Primary |
Addresses
Primary practice location
1400 Willow LN
N Wilkesboro, NC 28659-3551
Mailing address
284 Executive Park Dr
Ste 100
Concord, NC 28025-1833
Phone (704) 939-1100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861824682 | Medicaid | NC | |
| 19G4X | Other | NC | BCBS |
Other names 1
- Dan Icenhour
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C011464 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icenhour Therapy. PLLC | Clinical | Current | Accepting new patients |
Interoperability endpoints
- dan.icenhour.d1.p1@direct.daymarkrecovery.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- West Jefferson, NC
- NPI 1477357549
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1861824682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "284 EXECUTIVE PARK DR",
"address_2": "STE 100",
"city": "CONCORD",
"state": "NC",
"postal_code": "280251833",
"telephone_number": "704-939-1100",
"fax_number": "704-939-1173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 WILLOW LN",
"city": "N WILKESBORO",
"state": "NC",
"postal_code": "286593551",
"telephone_number": "336-667-5151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICENHOUR",
"first_name": "CHRISTOPHER",
"middle_name": "DANIEL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-02",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C011464",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861824682",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "19G4X",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DAN",
"last_name": "ICENHOUR",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in N Wilkesboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.