Provider Demographics
NPI:1447807342
Name:MCINTOSH LIFE COACH
Entity type:Organization
Organization Name:MCINTOSH LIFE COACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW, BCBA
Authorized Official - Phone:540-449-6240
Mailing Address - Street 1:1085 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-5891
Mailing Address - Country:US
Mailing Address - Phone:540-449-6240
Mailing Address - Fax:540-859-1472
Practice Address - Street 1:610 PEPPERS FRY RD NW STE E
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-5703
Practice Address - Country:US
Practice Address - Phone:814-572-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCINTOSH LIFE COACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-25
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty