Healthcare Provider Details

I. General information

NPI: 1487880316
Provider Name (Legal Business Name): CAMRON L WHITACRE MS.ED., LPCC-S, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 E DOROTHY LN SUITE 300B
KETTERING OH
45429-3897
US

IV. Provider business mailing address

1563 E DOROTHY LN SUITE 300B
KETTERING OH
45429-3897
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-6067
  • Fax: 937-938-6067
Mailing address:
  • Phone: 937-938-6067
  • Fax: 937-938-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004229A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0008476
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: