{
"Npi": {
"NPI": "1184143489",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EXTENSION TRAINING OF NC, 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": "1120 LOMBAR ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RALEIGH",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27610-6499",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-806-2156",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "700 MORROW AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PINEVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28134-6528",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-592-3608",
"PracticeLocationAddressFaxNumber": "919-835-9613",
"EnumerationDate": "09/18/2017",
"LastUpdateDate": "09/18/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEVENSON",
"AuthorizedOfficialFirstName": "CHRISTINA",
"AuthorizedOfficialMiddleName": "LANETTE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "FNP, ANP, RN-BC",
"AuthorizedOfficialTelephoneNumber": "919-592-3608",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "254418",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}