| Name: | Dr. Latisha Dailey LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 21 Mar 2022 (3 years ago) |
| Entity Number: | 001-009-804 |
| Register Number: | 001009804 |
| ZIP code: | 36303 |
| County: | Houston |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 212 W. Troy St. STE BDothan, AL 36303 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356054027 | 2022-12-27 | 2022-12-27 | 150 PATTERSON ST, ATMORE, AL, 365021818, US | 150 PATTERSON ST, ATMORE, AL, 365021818, US | |||||||||||||||||||
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| Phone | +1 251-359-6459 |
Authorized person
| Name | LATISHA DAILEY |
| Role | MENTAL BEHAVIOR |
| Phone | 2513596459 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1871202549 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| Registered Agents Inc | Agent | 212 W. Troy St., STE BDothan, AL 36303 |
| Name | Role | Address |
|---|---|---|
| Park, Riley | Organizer | 212 W. Troy St. STE BDothan, AL 36303 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
