Healthcare Provider Details

I. General information

NPI: 1316295728
Provider Name (Legal Business Name): ALLISON RICE CUSTAR LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON MARIE RICE LPCC-S

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 07/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 W. SPRING VALLEY PIKE
DAYTON OH
45458
US

IV. Provider business mailing address

1187 W. SPRING VALLEY PIKE
DAYTON OH
45458
US

V. Phone/Fax

Practice location:
  • Phone: 937-815-1670
  • Fax: 937-734-1343
Mailing address:
  • Phone: 937-815-1670
  • Fax: 937-734-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE0800415
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.800415-SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0800415
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.800415-SUPV
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0800415SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: