{
"Npi": {
"NPI": "1235412370",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ATIBA YOUTH INTERVENTION SERVICES, LLC",
"ParentOrgTIN": null,
"OrgName": "ATIBA YOUTH INTERVENTION SERVICES-DANVILLE, 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": "7825 MIDLOTHIAN TPKE STE 112",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH CHESTERFIELD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23235-5247",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7825 MIDLOTHIAN TPKE STE 112",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH CHESTERFIELD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23235-5247",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-272-2277",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/26/2011",
"LastUpdateDate": "09/26/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHEELER",
"AuthorizedOfficialFirstName": "DONALD",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BA, AAS, QMHP",
"AuthorizedOfficialTelephoneNumber": "804-272-2277",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "1181",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}