{
"Npi": {
"NPI": "1023913134",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE WELLNESS SHUFFLE LLC",
"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": "3211 FAIRINGTON DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LITHONIA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30038-5005",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3211 FAIRINGTON DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LITHONIA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30038-5005",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-656-3958",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/09/2026",
"LastUpdateDate": "10/09/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "TASHAYLA",
"AuthorizedOfficialMiddleName": "KEANDRA",
"AuthorizedOfficialTitle": "CO-OWNER, CLINICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD, LPC, NCC",
"AuthorizedOfficialTelephoneNumber": "912-656-3958",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}