Provider Demographics
NPI:1619474483
Name:SECOND ACTS
Entity Type:Organization
Organization Name:SECOND ACTS
Other - Org Name:LEARNINGRX LEESBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HOLLENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-465-2277
Mailing Address - Street 1:12532 MISTY WATER DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5702
Mailing Address - Country:US
Mailing Address - Phone:571-352-9792
Mailing Address - Fax:
Practice Address - Street 1:305 HARRISON ST SE STE 100A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3729
Practice Address - Country:US
Practice Address - Phone:571-465-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services