Provider Demographics
NPI:1316070535
Name:ACT-4
Entity type:Organization
Organization Name:ACT-4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:202-645-7277
Mailing Address - Street 1:1819 BURKE ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2512
Mailing Address - Country:US
Mailing Address - Phone:202-543-7747
Mailing Address - Fax:
Practice Address - Street 1:3849 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1001
Practice Address - Country:US
Practice Address - Phone:202-645-7272
Practice Address - Fax:202-645-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2025579251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management