Provider Demographics
NPI:1588107312
Name:MCINTOSH, DONNA HOLLAND
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:HOLLAND
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 ASHBY LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4353
Mailing Address - Country:US
Mailing Address - Phone:407-883-4407
Mailing Address - Fax:
Practice Address - Street 1:1951 NW 7TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1104
Practice Address - Country:US
Practice Address - Phone:305-902-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2024-04-04
Deactivation Date:2022-11-17
Deactivation Code:
Reactivation Date:2023-02-21
Provider Licenses
StateLicense IDTaxonomies
FLMH23554101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health