Healthcare Provider Details

I. General information

NPI: 1295258713
Provider Name (Legal Business Name): DANIELLE L MCINTYRE MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date: 02/23/2026
Reactivation Date: 03/16/2026

III. Provider practice location address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

111 WOODSIDE DR
SWANTON OH
43558-1137
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7700
  • Fax:
Mailing address:
  • Phone: 419-392-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1600735
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: