Provider Demographics
NPI:1073814265
Name:MCINTOSH, JEANNA RENEE (MA, LPC, LPCS, NCC)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:RENEE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MA, LPC, LPCS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 KINLEY RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9633
Mailing Address - Country:US
Mailing Address - Phone:803-381-5637
Mailing Address - Fax:803-753-0041
Practice Address - Street 1:1110 KINLEY RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9633
Practice Address - Country:US
Practice Address - Phone:803-381-5637
Practice Address - Fax:803-753-0041
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional