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Organization
ACT LIFE TRANSITIONS
Active
Organization
ACT LIFE TRANSITIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARRIE ERIN CONNELLY BCBA (COO OF CLINICAL PROGRAM DEVELOPMENT)
(321) 265-7557
Entity
Organization
Contact information
Practice address
2965 LIMPET CT, INDIALANTIC, FL 32903-1825
(321) 265-7557
Mailing address
2965 LIMPET CT, INDIALANTIC, FL 32903-1825
(321) 265-7557
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-04-2044
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-04-2044
BEHAVIOR ANALYSIS CERTIFICATION BOARD
—
Enumeration date
09/13/2017
Last updated
07/21/2022
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