Healthcare Provider Details

I. General information

NPI: 1215506282
Provider Name (Legal Business Name): WARRIORS CODE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 E JEFFERSON ST
PHOENIX AZ
85034-2312
US

IV. Provider business mailing address

1246 E JEFFERSON ST
PHOENIX AZ
85034-2312
US

V. Phone/Fax

Practice location:
  • Phone: 602-653-3022
  • Fax:
Mailing address:
  • Phone: 602-653-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY NEWKIRK
Title or Position: FOUNDER/CEO
Credential: PHD
Phone: 602-653-3022