Healthcare Provider Details

I. General information

NPI: 1598377459
Provider Name (Legal Business Name): KIANNA LASHAY MCINTOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MOORES MILL RD STE A
NEW MARKET AL
35761-8447
US

IV. Provider business mailing address

160 STONE PARK BLVD APT 412
PIKE ROAD AL
36064-2991
US

V. Phone/Fax

Practice location:
  • Phone: 256-951-0555
  • Fax:
Mailing address:
  • Phone: 256-951-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5974C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: