Organization
DECODED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATEEFAH N APPLEBERRY MSW (CEO)
(937) 718-3557
Entity
Organization
Contact information
Practice address
120 W 2ND ST STE 703, DAYTON, OH 45402-1192
(937) 588-8426
Mailing address
2829 TUBMAN AVE, DAYTON, OH 45417-4240
(937) 718-3557
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/27/2024
Last updated
10/02/2024
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