Healthcare Provider Details

I. General information

NPI: 1588090385
Provider Name (Legal Business Name): LEAH K. MCINTIRE L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 COMMERCE DR STE B
MORGANTOWN WV
26501-3874
US

IV. Provider business mailing address

1000 TECHNOLOGY DR STE 2320
FAIRMONT WV
26554-8824
US

V. Phone/Fax

Practice location:
  • Phone: 304-241-1708
  • Fax: 304-391-2054
Mailing address:
  • Phone: 304-368-2740
  • Fax: 304-368-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2014
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: