Healthcare Provider Details

I. General information

NPI: 1770403602
Provider Name (Legal Business Name): MR. CAMERON ALEXANDER HAMPTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DOUGLAS ST
PETALUMA CA
94952-2567
US

IV. Provider business mailing address

306 GATE WAY
SANTA ROSA CA
95401-8418
US

V. Phone/Fax

Practice location:
  • Phone: 707-778-4813
  • Fax:
Mailing address:
  • Phone: 858-243-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number136192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: