Provider Demographics
NPI:1568960128
Name:MY ALL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:MY ALL ENTERPRISES, INC.
Other - Org Name:MY ALL THERAPY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ETTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-797-9620
Mailing Address - Street 1:3353 GLADE CREEK BLVD NE APT 11
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-8659
Mailing Address - Country:US
Mailing Address - Phone:540-797-9620
Mailing Address - Fax:
Practice Address - Street 1:131 OLD BROOK RD STE C
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-4301
Practice Address - Country:US
Practice Address - Phone:540-797-9620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty