Healthcare Provider Details

I. General information

NPI: 1902648637
Provider Name (Legal Business Name): VISUALIZE WELLNESS LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 XENIA AVE
DAYTON OH
45410-1823
US

IV. Provider business mailing address

5730 HEATHER HOLLOW DR
DAYTON OH
45415-2607
US

V. Phone/Fax

Practice location:
  • Phone: 937-248-1682
  • Fax:
Mailing address:
  • Phone: 937-248-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. EARL WHITE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 937-248-1682