Individual
WAYNE R MACINTOSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LLP
Contact information
Practice address
331 CAMPBELL THICKETT RD, RIDGEVILLE, SC 29472-6339
(843) 821-2073
Mailing address
204 ELM HALL CIR, SUMMERVILLE, SC 29483-1613
(248) 767-6368
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301010026
MI
Other
Enumeration date
02/05/2010
Last updated
11/12/2015
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