Healthcare Provider Details

I. General information

NPI: 1871448241
Provider Name (Legal Business Name): ANCELIA DEKONTEE NIMELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OBETZ RD
COLUMBUS OH
43207-4036
US

IV. Provider business mailing address

600 WAYNE AVE
DAYTON OH
45410-1122
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2000
  • Fax:
Mailing address:
  • Phone: 937-496-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: