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General NPI Number Information
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NPI Number | 1598290363
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Entity Type | Organization
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Legal Business Name | MY LIFE MY WAY INC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 115 AIKENS CTR SUITE 10
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City | MARTINSBURG
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State | WV
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Zip | 25404-6210
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Country | US
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Telephone | 304-676-4260
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Fax | 304-596-2333
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Provider Business Mailing Address
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Address Line | 115 AIKENS CTR SUITE 10
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City | MARTINSBURG
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State | WV
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Zip | 25404-6210
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Country | US
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Telephone | 304-676-4260
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Fax | 304-596-2333
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARGARET SOMMER
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Credential | LSW
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Telephone | 304-676-4260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | AP00942627
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License Number State | WV
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