Provider Demographics
NPI:1659715480
Name:RUSH, CHASITY A (LICDC-CS, LPPCC-S)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:A
Last Name:RUSH
Suffix:
Gender:F
Credentials:LICDC-CS, LPPCC-S
Other - Prefix:
Other - First Name:CHASITY
Other - Middle Name:A
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3913 KENTON CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-2406
Mailing Address - Country:US
Mailing Address - Phone:513-470-8147
Mailing Address - Fax:
Practice Address - Street 1:2600 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1395
Practice Address - Country:US
Practice Address - Phone:513-751-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.121117-CS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)