Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003252677 |
---|---|
Provider Name | Mr. Bernard Mcintosh |
First Address | Lake City, SC 29560-3806 |
Second Address | Florence, SC 29506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 22/05/2013 |