Provider Demographics
NPI:1396998480
Name:ACT FAMILY PROGRAM
Entity type:Organization
Organization Name:ACT FAMILY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:540-220-2703
Mailing Address - Street 1:39 GARRETT STREET
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-2221
Mailing Address - Fax:540-347-2221
Practice Address - Street 1:39 GARRETT STREET
Practice Address - Street 2:SUITE 109
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-347-2221
Practice Address - Fax:540-347-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1172251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health