{
"Npi": {
"NPI": "1174654198",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JACOBI-EDWARDS",
"FirstName": "DEE",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "M.ED., LPTA, LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BUCHANAN & DELMONTE",
"OtherFirstName": "DONNA",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "M.ED., CRC, LPTA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "313 JAMESBURY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHARLESTON",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29492-7814",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-998-1980",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3300 W MONTAGUE AVE STE 203",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "N CHARLESTON",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29418-5907",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-740-6999",
"PracticeLocationAddressFaxNumber": "843-740-5433",
"EnumerationDate": "03/08/2007",
"LastUpdateDate": "04/01/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "58863",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "0904011004",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "C012079",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "2794",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "004753-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "2057623",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225C00000X",
"TaxonomyName": "Rehabilitation Counselor",
"LicenseNumber": "00088976",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "12955",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}