Provider Demographics
NPI:1447628268
Name:MCINTOSH-HALL, TERESA L (MS, LSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:MCINTOSH-HALL
Suffix:
Gender:F
Credentials:MS, LSW
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LSW
Mailing Address - Street 1:7911 WELLBAUM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-9214
Mailing Address - Country:US
Mailing Address - Phone:937-641-9230
Mailing Address - Fax:
Practice Address - Street 1:1349 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4925
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1440148104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker