Provider Demographics
NPI:1306948666
Name:CUSTER, VICKI (MA, LCPC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 ALGONQUIN RD
Mailing Address - Street 2:SUITE 714
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3126
Mailing Address - Country:US
Mailing Address - Phone:847-840-6680
Mailing Address - Fax:
Practice Address - Street 1:3601 ALGONQUIN RD
Practice Address - Street 2:SUITE 714
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3126
Practice Address - Country:US
Practice Address - Phone:847-840-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional