Healthcare Provider Details

I. General information

NPI: 1972547941
Provider Name (Legal Business Name): MAX MARIE MCINTOSH LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 BRIARCLIFF RD SUITE B
WINSTON-SALEM NC
27106-3077
US

IV. Provider business mailing address

5025 ELTHA DR APT. G
WINSTON-SALEM NC
27105-1112
US

V. Phone/Fax

Practice location:
  • Phone: 336-682-3519
  • Fax: 336-773-0332
Mailing address:
  • Phone: 336-682-3519
  • Fax: 336-773-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: