Healthcare Provider Details

I. General information

NPI: 1699694364
Provider Name (Legal Business Name): SANDRIKA L MEDLOCK PEER SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RISING HANDS LLC PEER SPECIALIST

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41924 W MICHAELS DR
MARICOPA AZ
85138-8649
US

IV. Provider business mailing address

44920 W HATHAWAY AVE UNIT 141
MARICOPA AZ
85139-9913
US

V. Phone/Fax

Practice location:
  • Phone: 480-567-6163
  • Fax:
Mailing address:
  • Phone: 480-567-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: