Healthcare Provider Details

I. General information

NPI: 1053755116
Provider Name (Legal Business Name): CELESTINE MCINTOSH LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N ACADEMY ST
KINGSTREE SC
29556-3408
US

IV. Provider business mailing address

500 N ACADEMY ST
KINGSTREE SC
29556-3408
US

V. Phone/Fax

Practice location:
  • Phone: 843-355-5533
  • Fax: 843-355-6297
Mailing address:
  • Phone: 843-355-5533
  • Fax: 843-355-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: