{
"Npi": {
"NPI": "1043657075",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AVENUES OF CHANGE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "132 GALLERY COURT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ACWORTH",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30101",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-713-4574",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1568 CLOVERDALE DR SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARIETTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30067-7406",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-713-4574",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/31/2013",
"LastUpdateDate": "05/31/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMOLKO-SELF",
"AuthorizedOfficialFirstName": "MARYANN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/LPC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "7707134574",
"AuthorizedOfficialTelephoneNumber": "770-713-4574",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "LPC004657",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}