Healthcare Provider Details

I. General information

NPI: 1588107312
Provider Name (Legal Business Name): DONNA HOLLAND MCINTOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date: 11/17/2022
Reactivation Date: 02/21/2023

III. Provider practice location address

1951 NW 7TH AVE FL 3
MIAMI FL
33136-1104
US

IV. Provider business mailing address

567 ASHBY LANDING WAY
SAINT AUGUSTINE FL
32086-4353
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-6347
  • Fax:
Mailing address:
  • Phone: 407-883-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23554
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: