Provider Demographics
NPI:1346764578
Name:TRICE, SHAVON (LCDCIII)
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:TRICE
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SYCAMORE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1305
Mailing Address - Country:US
Mailing Address - Phone:513-354-6697
Mailing Address - Fax:
Practice Address - Street 1:909 SYCAMORE ST STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1305
Practice Address - Country:US
Practice Address - Phone:513-354-6697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161458101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH161458OtherLCDCIII