Basic Information
| Provider Information | |||||||||
| NPI: | 1689239600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCINTIRE | ||||||||
| FirstName: | NICHOLE | ||||||||
| MiddleName: | MONIQUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1621 W 226TH ST APT 4 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905016627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4244075340 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907313711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105219209 | ||||||||
| FaxNumber: | 3105219241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2019 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.