Provider Demographics
NPI:1083833776
Name:MCINTOSH, MARTHA JEAN (LPC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JEAN
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3522 S WAKEFIELD ST APT A1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1728
Mailing Address - Country:US
Mailing Address - Phone:703-998-9146
Mailing Address - Fax:
Practice Address - Street 1:5999 STEVENSON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3304
Practice Address - Country:US
Practice Address - Phone:703-823-9800
Practice Address - Fax:703-823-0252
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional