Provider Demographics
NPI:1487880316
Name:WHITACRE, CAMRON L (MSED, LPCC-S, LMHC)
Entity type:Individual
Prefix:
First Name:CAMRON
Middle Name:L
Last Name:WHITACRE
Suffix:
Gender:M
Credentials:MSED, LPCC-S, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 E DOROTHY LN
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3897
Mailing Address - Country:US
Mailing Address - Phone:937-938-6067
Mailing Address - Fax:937-938-6067
Practice Address - Street 1:1563 E DOROTHY LN
Practice Address - Street 2:SUITE 300B
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3897
Practice Address - Country:US
Practice Address - Phone:937-938-6067
Practice Address - Fax:937-938-6067
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0008476101YP2500X
IN39004229A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178113Medicaid