Provider Demographics
NPI:1447807342
Name:COMMUNITY COUNSELING
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING
Other - Org Name:MCINTOSH LIFECOACH
Other - Org Type:Doing Business As
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: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:814-572-4708
Mailing Address - Fax:
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-25
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty