{
"Npi": {
"NPI": "1003545013",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FENAUD",
"FirstName": "DENARD",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LMSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "101 GREATWOOD LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VILLA RICA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30180-5565",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "772-408-3907",
"MailingAddressFaxNumber": "678-855-6715",
"FirstLinePracticeLocationAddress": "101 GREATWOOD LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VILLA RICA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30180-5565",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "772-408-3907",
"PracticeLocationAddressFaxNumber": "678-855-6715",
"EnumerationDate": "06/06/2022",
"LastUpdateDate": "05/30/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "MSW011595",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "0903004043",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "MSW011595",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "6851114226",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "MSW011595",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}