Provider Demographics
NPI:1902207384
Name:MCINTOSH, KATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:HUTTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:136 FAIRVIEW RD STE 125
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8547
Mailing Address - Country:US
Mailing Address - Phone:704-677-7635
Mailing Address - Fax:980-435-0398
Practice Address - Street 1:136 FAIRVIEW RD STE 125
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8547
Practice Address - Country:US
Practice Address - Phone:704-677-7635
Practice Address - Fax:980-435-0398
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0088581041C0700X
NCC0102921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical