Organization
FATHERHOOD REVISITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KEISHA RENEE PETTIJOHN (CEO/FOUNDER)
(513) 549-4172
Entity
Organization
Contact information
Practice address
10925 REED HARTMAN HWY STE 310C, BLUE ASH, OH 45242-2842
(513) 549-4172
(513) 586-0452
Mailing address
PO BOX 12685, CINCINNATI, OH 45212-0685
(513) 549-4172
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/06/2016
Last updated
03/14/2022
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