Wayne R Macintosh, MA, LLP
Individual provider Active NPI Clinical Psychologist · Ridgeville, SC
NPI 1295067973 · NPPES record last updated Nov 12, 2015
Key facts
- NPI
- 1295067973
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 6301010026 (MI)
- Practice address
- 331 Campbell Thickett Rd
Ridgeville, SC 29472-6339 - Phone
- (843) 821-2073
- NPI assigned
- Feb 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301010026 | MI | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301010026 | MI | Yes |
Addresses
Primary practice location
331 Campbell Thickett Rd
Ridgeville, SC 29472-6339
Mailing address
204 Elm Hall Cir
Summerville, SC 29483-1613
Phone (248) 767-6368
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All providers in Ridgeville, SC · Clinical Psychologist in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.