Doctor Name: | MRS. LISA MARIE MCINTYRE |
NPI Number: | 1750644902 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LPC005704 |
Business Practice Address: | 198 Union Hill Church Rd Gordon, GA - 310312134 |
Business Phone Number: | 4782516611 |
Business Fax Number: | |
Mailing Address: | 198 Union Hill Church Rd, GORDON |
State: | GA |
Postal Code: | 310312134 |
Phone Number: | 4782516611 |
Fax Number: | |
NPI Enumeration Date: | 06/22/2012 |
NPI Last Update Date: | 06/22/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPC005704 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |