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General NPI Number Information
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NPI Number | 1104302611
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Entity Type | Organization
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Legal Business Name | ELIZABETH MCINTOSH, LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 2324 W JOPPA RD STE 130
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4615
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Country | US
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Telephone | 410-258-5681
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Fax |
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Provider Business Mailing Address
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Address Line | 49 CEDAR CHIP CT
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City | PARKVILLE
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State | MD
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Zip | 21234-8035
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RESIDENT AGENT
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Name | ELIZABETH MCINTOSH
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Credential | MS, LCPC
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Telephone | 410-258-5681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC6434
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License Number State | MD
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