Healthcare Provider Details

I. General information

NPI: 1588232144
Provider Name (Legal Business Name): KWAME MCINTOSH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-2408
US

IV. Provider business mailing address

7514 HAWTHORNE ST APT 6
HYATTSVILLE MD
20785-2658
US

V. Phone/Fax

Practice location:
  • Phone: 202-878-6626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLG50080854
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG50080854
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: