Healthcare Provider Details

I. General information

NPI: 1609771732
Provider Name (Legal Business Name): MAX MCINTOSH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 AZURE LN UNIT 204
WINSTON SALEM NC
27127-3245
US

IV. Provider business mailing address

1635 AZURE LN UNIT 204
WINSTON SALEM NC
27127-3245
US

V. Phone/Fax

Practice location:
  • Phone: 336-406-9861
  • Fax: 980-598-1523
Mailing address:
  • Phone: 336-406-9861
  • Fax: 980-598-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAX MARIE MCINTOSH
Title or Position: OWNER
Credential: LCMHC-S
Phone: 336-406-9861