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General NPI Number Information
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NPI Number | 1225556244
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Entity Type | Organization
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Legal Business Name | ACT LIFE TRANSITIONS, LLC.
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2965 LIMPET CT
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City | INDIALANTIC
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State | FL
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Zip | 32903-1825
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Country | US
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Telephone | 321-265-7557
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Fax |
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Provider Business Mailing Address
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Address Line | 2965 LIMPET CT
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City | INDIALANTIC
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State | FL
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Zip | 32903-1825
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Country | US
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Telephone | 321-265-7557
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Fax |
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Authorized Official
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Title or Position | COO DIR. CLINICAL PROGRAMMING
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Name | MS. CARRIE ERIN CONNELLY
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Credential | MS, BCBA
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Telephone | 321-265-7557
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-04-2044
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License Number State | FL
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