{
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"FirstLineMailingAddress": "2818 WHISKER WAY",
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"PracticeLocationAddressCityName": "BRYANT",
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"EnumerationDate": "04/20/2023",
"LastUpdateDate": "04/24/2024",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "WALKER",
"AuthorizedOfficialFirstName": "MARQUIS",
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"AuthorizedOfficialCredential": "LCSW",
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{
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}
]
},
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}