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General NPI Number Information
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NPI Number | 1790054542
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Entity Type | Organization
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Legal Business Name | C2ACT, LLC
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Dates
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Enumeration Date | 12/23/2011
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 3417 N KENNICOTT AVE STE A
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-7824
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Country | US
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Telephone | 224-210-6694
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Fax | 224-836-5174
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Provider Business Mailing Address
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Address Line | 3417 N KENNICOTT AVE STE A
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-7824
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Country | US
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Telephone | 224-210-6694
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Fax | 224-836-5174
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MARJORIE DIAZ RODRIGUEZ
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Credential | MA
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Telephone | 224-210-6694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149011093
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License Number State | IL
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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