Provider Demographics
NPI:1477193381
Name:WARRIOR'S WALK INTEGRATED COUNSELING LLC
Entity Type:Organization
Organization Name:WARRIOR'S WALK INTEGRATED COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCINONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:802-310-6099
Mailing Address - Street 1:346 BRADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-4439
Mailing Address - Country:US
Mailing Address - Phone:802-310-6099
Mailing Address - Fax:
Practice Address - Street 1:13 ARCADIA RD STE 1
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1743
Practice Address - Country:US
Practice Address - Phone:888-974-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty