Provider Demographics
NPI:1538542543
Name:MCINTYRE, NICKKIA (LCSWA)
Entity type:Individual
Prefix:MS
First Name:NICKKIA
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 FOXBERRY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1881
Mailing Address - Country:US
Mailing Address - Phone:910-574-1301
Mailing Address - Fax:
Practice Address - Street 1:6501 FOXBERRY RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1881
Practice Address - Country:US
Practice Address - Phone:910-574-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0091381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical