{
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"LastName": null,
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"FirstLineMailingAddress": "PO BOX 10761",
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"MailingAddressCityName": "LYNCHBURG",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24506-0761",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "434-258-6163",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "290 CLOVER LN",
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"PracticeLocationAddressCityName": "BRISTOL",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/04/2022",
"LastUpdateDate": "03/04/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARRISON",
"AuthorizedOfficialFirstName": "CHRISTINA",
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"AuthorizedOfficialTitle": "OWNER, PROVIDER",
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"AuthorizedOfficialTelephoneNumber": "434-258-6163",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}