{
"Npi": {
"NPI": "1184844599",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "LDS FAMILY SERVICES",
"ParentOrgTIN": null,
"OrgName": "LDS FAMILY SERVICES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7621 LITTLE AVE",
"SecondLineMailingAddress": "SUITE 420",
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28226-8368",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-541-5626",
"MailingAddressFaxNumber": "704-541-9284",
"FirstLinePracticeLocationAddress": "7621 LITTLE AVE",
"SecondLinePracticeLocationAddress": "SUITE 420",
"PracticeLocationAddressCityName": "CHARLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28226-8368",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-541-5626",
"PracticeLocationAddressFaxNumber": "704-541-9284",
"EnumerationDate": "04/26/2007",
"LastUpdateDate": "06/06/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARRETT",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "704-541-5626",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "261QMO801X26",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}