Provider Demographics
NPI:1770394785
Name:WHITE, CAMERON WAYNE
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:WAYNE
Last Name:WHITE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 COQUINA KEY DR APT F
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-8085
Mailing Address - Country:US
Mailing Address - Phone:765-617-6031
Mailing Address - Fax:
Practice Address - Street 1:5905 COQUINA KEY DR APT F
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-8085
Practice Address - Country:US
Practice Address - Phone:765-617-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health