Provider Demographics
NPI:1316295728
Name:CUSTAR, ALLISON RICE (LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RICE
Last Name:CUSTAR
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:1187 W. SPRING VALLEY PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:937-815-1670
Mailing Address - Fax:937-734-1343
Practice Address - Street 1:1187 W. SPRING VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-815-1670
Practice Address - Fax:937-734-1343
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0800415SUPV101YP2500X
OHE0800415101Y00000X, 101YM0800X
OHE.800415-SUPV101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0183011Medicaid