Provider Demographics
NPI:1609380625
Name:MCINTYRE, CHRISTY LEWIS (LCSW-A)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEWIS
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 OAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3621
Mailing Address - Country:US
Mailing Address - Phone:910-297-3709
Mailing Address - Fax:
Practice Address - Street 1:7345 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3621
Practice Address - Country:US
Practice Address - Phone:910-297-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP011760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker