{
"Npi": {
"NPI": "1538746300",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WADE",
"FirstName": "CAMERON",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "RDT, LCASA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3710 UNIVERSITY DR STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DURHAM",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27707-6208",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-906-4390",
"MailingAddressFaxNumber": "919-287-2707",
"FirstLinePracticeLocationAddress": "3710 UNIVERSITY DR STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DURHAM",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27707-6208",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-906-4390",
"PracticeLocationAddressFaxNumber": "919-287-2707",
"EnumerationDate": "03/26/2021",
"LastUpdateDate": "07/31/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101200000X",
"TaxonomyName": "Drama Therapist",
"LicenseNumber": "712",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "30323",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}