Organization
SOUTH COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA BUCK MS, PCC-S (YPH PROGRAM MANAGER)
(937) 258-4246
Entity
Organization
Contact information
Practice address
2745 S SMITHVILLE RD, KETTERING, OH 45420-2668
(937) 258-4246
Mailing address
8130 TOWSON BLVD, MIAMISBURG, OH 45342-6120
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/01/2014
Last updated
11/01/2014
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