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General NPI Number Information
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NPI Number | 1902602923
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Entity Type | Organization
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Legal Business Name | ARIZONA PEER ALLIANCE LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 17404 N JAVELINA DR
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City | SURPRISE
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State | AZ
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Zip | 85374-2955
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Country | US
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Telephone | 623-606-7994
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Fax |
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Provider Business Mailing Address
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Address Line | 17404 N JAVELINA DR
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City | SURPRISE
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State | AZ
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Zip | 85374-2955
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Country | US
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Telephone | 623-606-7994
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Fax |
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Authorized Official
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Title or Position | PARTNER/PROVIDER
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Name | CARRIE MARDULA
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Credential | MS LPC
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Telephone | 623-606-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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