NPI Code Detail JSON Logo

1114675998 NPI number — QUEER WAVE COUNSELING, PLLC

NPI Number: 1114675998
Health Care Provider/Practitioner: QUEER WAVE COUNSELING, PLLC

Information about “1114675998” NPI (QUEER WAVE COUNSELING, PLLC) exists in 1114675998 in HTML format HTML  |  1114675998 in plain Text format TXT  |  1114675998 in PDF (Portable Document Format) PDF  |  1114675998 in an XML format XML  formats.

NPI Number : 1114675998 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114675998",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "QUEER WAVE COUNSELING, PLLC",
    "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": "766 MOORES POND RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "YOUNGSVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27596-8199",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-236-3211",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "766 MOORES POND RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "YOUNGSVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27596-8199",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-236-3211",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/11/2022",
    "LastUpdateDate": "03/11/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LICALZI",
    "AuthorizedOfficialFirstName": "JEFFREY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/PSYCHOTHERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCMHCA",
    "AuthorizedOfficialTelephoneNumber": "919-236-3211",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0850X",
        "TaxonomyName": "Adult Mental Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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