Provider Demographics
NPI:1609331750
Name:MCINTYRE, PATRICIA SIMONE (CSAC,LPCA,LCASA,NCC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SIMONE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:CSAC,LPCA,LCASA,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MARCELLA DR
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-9251
Mailing Address - Country:US
Mailing Address - Phone:704-473-5450
Mailing Address - Fax:
Practice Address - Street 1:313 MARCELLA DR
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-9251
Practice Address - Country:US
Practice Address - Phone:704-473-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-03
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14634101YM0800X
NC25243101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health