Provider Demographics
NPI:1982330114
Name:CAMERON, ALIZEDRAIN SHYKE (LCSWA)
Entity Type:Individual
Prefix:
First Name:ALIZEDRAIN
Middle Name:SHYKE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6977 NEXUS CT STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2651
Mailing Address - Country:US
Mailing Address - Phone:910-672-6432
Mailing Address - Fax:910-745-7907
Practice Address - Street 1:6977 NEXUS CT STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2651
Practice Address - Country:US
Practice Address - Phone:910-672-6432
Practice Address - Fax:910-745-7907
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0178541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
08122000OtherDATE OF BIRTH