Provider Demographics
NPI:1699821462
Name:MCINTOSH, MICHELLE LONG (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LONG
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 CENTURY BLVD NE STE 8
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3315
Mailing Address - Country:US
Mailing Address - Phone:404-320-6906
Mailing Address - Fax:404-320-6907
Practice Address - Street 1:1925 CENTURY BLVD NE STE 8
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3315
Practice Address - Country:US
Practice Address - Phone:404-320-6906
Practice Address - Fax:404-320-6907
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004319101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor