Provider Demographics
NPI:1902532815
Name:MCINTOSH, JOSEPH COREY (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:COREY
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 QUEENSBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4899
Mailing Address - Country:US
Mailing Address - Phone:336-324-1538
Mailing Address - Fax:
Practice Address - Street 1:8311 BRIER CREEK PKWY STE 105-167
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7328
Practice Address - Country:US
Practice Address - Phone:919-713-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health