Healthcare Provider Details

I. General information

NPI: 1992201156
Provider Name (Legal Business Name): A & C SUPPORT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 12/08/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 BELLE VIEW BLVD # 3015
ALEXANDRIA VA
22307-6531
US

IV. Provider business mailing address

1602 BELLE VIEW BLVD # 3015
ALEXANDRIA VA
22307-6531
US

V. Phone/Fax

Practice location:
  • Phone: 703-659-8404
  • Fax:
Mailing address:
  • Phone: 540-307-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. EBONY HOUZE
Title or Position: CEO
Credential:
Phone: 703-659-8404