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1093111049 NPI number — FIRST RESPONSE COUNSELING & INTERVENTION LLC

NPI Number: 1093111049
Health Care Provider/Practitioner: FIRST RESPONSE COUNSELING & INTERVENTION LLC

Information about “1093111049” NPI (FIRST RESPONSE COUNSELING & INTERVENTION LLC) exists in 1093111049 in HTML format HTML  |  1093111049 in plain Text format TXT  |  1093111049 in PDF (Portable Document Format) PDF  |  1093111049 in an XML format XML  formats.

NPI Number : 1093111049 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093111049",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FIRST RESPONSE COUNSELING & INTERVENTION LLC",
    "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": "6053 N HENRY BLVD",
    "SecondLineMailingAddress": "SUITE C",
    "MailingAddressCityName": "STOCKBRIDGE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30281-3081",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-545-4285",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6053 N HENRY BLVD",
    "SecondLinePracticeLocationAddress": "SUITE C",
    "PracticeLocationAddressCityName": "STOCKBRIDGE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30281-3081",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-545-4285",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/18/2014",
    "LastUpdateDate": "11/18/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KELLAM",
    "AuthorizedOfficialFirstName": "DAMIEN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT & CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.A.,LPC,PHD ABD",
    "AuthorizedOfficialTelephoneNumber": "678-545-4285",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LPC005856",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LPC005815",
          "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."
        },
        {
          "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."
        }
      ]
    }
  }
}
                
            

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