Provider Demographics
NPI:1225556244
Name:ACT LIFE TRANSITIONS, LLC.
Entity Type:Organization
Organization Name:ACT LIFE TRANSITIONS, LLC.
Other - Org Name:ACT LIFE TRANSITIONS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO DIR. CLINICAL PROGRAMMING
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:321-265-7557
Mailing Address - Street 1:2965 LIMPET CT
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-1825
Mailing Address - Country:US
Mailing Address - Phone:321-265-7557
Mailing Address - Fax:
Practice Address - Street 1:2965 LIMPET CT
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-1825
Practice Address - Country:US
Practice Address - Phone:321-265-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-04-2044103K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty