Provider Demographics
NPI:1881425809
Name:ACT BEHAVIOR CENTER
Entity type:Organization
Organization Name:ACT BEHAVIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-631-9623
Mailing Address - Street 1:2464 SUSIE BRUMLEY PL NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2464 SUSIE BRUMLEY PL NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3313
Practice Address - Country:US
Practice Address - Phone:630-631-9623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty