Healthcare Provider Details

I. General information

NPI: 1790054542
Provider Name (Legal Business Name): C2ACT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 N KENNICOTT AVE STE A
ARLINGTON HEIGHTS IL
60004-7824
US

IV. Provider business mailing address

3417 N KENNICOTT AVE STE A
ARLINGTON HEIGHTS IL
60004-7824
US

V. Phone/Fax

Practice location:
  • Phone: 224-210-6694
  • Fax: 224-836-5174
Mailing address:
  • Phone: 224-210-6694
  • Fax: 224-836-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number149011093
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARJORIE DIAZ RODRIGUEZ
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: MA
Phone: 224-210-6694