Healthcare Provider Details

I. General information

NPI: 1538746300
Provider Name (Legal Business Name): CAMERON WADE RDT, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

IV. Provider business mailing address

3710 UNIVERSITY DR STE 100
DURHAM NC
27707-6208
US

V. Phone/Fax

Practice location:
  • Phone: 919-906-4390
  • Fax: 919-287-2707
Mailing address:
  • Phone: 919-906-4390
  • Fax: 919-287-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number712
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30323
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: