{
"Npi": {
"NPI": "1003960022",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHEASTERN COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1 MONTAUK AVE STE 301",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW LONDON",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06320-4967",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-447-1717",
"MailingAddressFaxNumber": "860-887-0007",
"FirstLinePracticeLocationAddress": "37 CAMP MOOWEEN ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEBANON",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06249",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-889-1717",
"PracticeLocationAddressFaxNumber": "860-886-2361",
"EnumerationDate": "01/23/2007",
"LastUpdateDate": "03/09/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAWTON",
"AuthorizedOfficialFirstName": "STACEY",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMSW",
"AuthorizedOfficialTelephoneNumber": "860-579-3616",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "0439",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "SA-0018",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "SA0020",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}