Provider Demographics
NPI:1407210438
Name:MY LIFE, MY WAY, INC.
Entity Type:Organization
Organization Name:MY LIFE, MY WAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:304-350-8871
Mailing Address - Street 1:300 FOXCROFT AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-5341
Mailing Address - Country:US
Mailing Address - Phone:304-350-8871
Mailing Address - Fax:681-260-2960
Practice Address - Street 1:300 FOXCROFT AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5341
Practice Address - Country:US
Practice Address - Phone:304-350-8871
Practice Address - Fax:681-260-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV441251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health