Healthcare Provider Details

I. General information

NPI: 1043857386
Provider Name (Legal Business Name): WALK WITH ME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 LB PROPST DR
CONOVER NC
28613-8830
US

IV. Provider business mailing address

4108 LB PROPST DR
CONOVER NC
28613-8830
US

V. Phone/Fax

Practice location:
  • Phone: 828-302-3431
  • Fax:
Mailing address:
  • Phone: 828-302-3431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BANDY
Title or Position: OWNER
Credential:
Phone: 828-302-3431