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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