Provider Demographics
NPI:1639862857
Name:MICAH'S WALK FOR AUTISM
Entity Type:Organization
Organization Name:MICAH'S WALK FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTE
Authorized Official - Middle Name:TASHAY
Authorized Official - Last Name:FORD MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, BSHA
Authorized Official - Phone:662-263-6044
Mailing Address - Street 1:424 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4155
Mailing Address - Country:US
Mailing Address - Phone:662-263-6044
Mailing Address - Fax:
Practice Address - Street 1:424 SHADOWOOD DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4155
Practice Address - Country:US
Practice Address - Phone:662-263-6044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare