{
"Npi": {
"NPI": "1184057945",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CARR",
"FirstName": "TIESHA",
"MiddleName": "MIA",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "ED.D, LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CARR",
"OtherFirstName": "T. MIA",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "ED.D, LPC",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1293 N LAKEVIEW DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALATINE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60067-2093",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-850-1701",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1293 N LAKEVIEW DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALATINE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60067-2093",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "985-326-1882",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/15/2013",
"LastUpdateDate": "09/06/2021",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "0701007337",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "LC6047",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "7111",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}