Provider Demographics
NPI:1972547941
Name:MCINTOSH, MAX MARIE (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MAX
Middle Name:MARIE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 ELTHA DR
Mailing Address - Street 2:APT. G
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-1112
Mailing Address - Country:US
Mailing Address - Phone:336-682-3519
Mailing Address - Fax:336-773-0332
Practice Address - Street 1:2910 BRIARCLIFF RD
Practice Address - Street 2:SUITE B
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3077
Practice Address - Country:US
Practice Address - Phone:336-682-3519
Practice Address - Fax:336-773-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103082Medicaid
67403OtherNCC
NC4102OtherLPC