Provider Demographics
NPI:1184422370
Name:ACT WELLNESS INSTITUTE, LLC
Entity type:Organization
Organization Name:ACT WELLNESS INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TANEASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-379-9328
Mailing Address - Street 1:10440 LITTLE PATUXENT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3648
Mailing Address - Country:US
Mailing Address - Phone:667-379-9328
Mailing Address - Fax:
Practice Address - Street 1:10440 LITTLE PATUXENT PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3648
Practice Address - Country:US
Practice Address - Phone:667-379-9328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty