Provider Demographics
NPI:1376054627
Name:MCINTYRE, PAULISHA DA-SHAWNA (BSW, MSW, LCSW-A)
Entity Type:Individual
Prefix:MS
First Name:PAULISHA
Middle Name:DA-SHAWNA
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:BSW, MSW, LCSW-A
Other - Prefix:
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Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:650 HIGHLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101
Practice Address - Country:US
Practice Address - Phone:336-607-8523
Practice Address - Fax:336-773-0913
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP0120701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical