Provider Demographics
NPI:1770283442
Name:MY WALK OF LIFE INC.
Entity type:Organization
Organization Name:MY WALK OF LIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:GIDDINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:704-858-1640
Mailing Address - Street 1:150 OAKLAND AVE STE 233
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4073
Mailing Address - Country:US
Mailing Address - Phone:704-858-1640
Mailing Address - Fax:803-630-1843
Practice Address - Street 1:908 MORETZ AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2127
Practice Address - Country:US
Practice Address - Phone:803-610-1930
Practice Address - Fax:803-630-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health