Provider Demographics
NPI:1700232584
Name:MCINTOSH, DYSHAYA
Entity Type:Individual
Prefix:
First Name:DYSHAYA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BOULWARE RD
Mailing Address - Street 2:306
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-8212
Mailing Address - Country:US
Mailing Address - Phone:646-351-5360
Mailing Address - Fax:
Practice Address - Street 1:44 BOULWARE RD
Practice Address - Street 2:306
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8212
Practice Address - Country:US
Practice Address - Phone:646-351-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst