1255873709 NPI number — DOROTHY A. FONDI MS, LPC, CPCS, MAC

NPI Number: 1255873709
Health Care Provider/Practitioner: DOROTHY A. FONDI MS, LPC, CPCS, MAC

NPI Number : 1255873709 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255873709",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FONDI",
    "FirstName": "DOROTHY",
    "MiddleName": "A.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, LPC, CPCS, MAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FORTUCHANG",
    "OtherFirstName": "DOROTHY",
    "OtherMiddleName": "A.",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LPC, CPCS, MAC, NCC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "157 SMITH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JONESBORO",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30236-3546",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-473-2418",
    "MailingAddressFaxNumber": "770-473-9772",
    "FirstLinePracticeLocationAddress": "853 BATTLECREEK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JONESBORO",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30236-1919",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-473-2620",
    "PracticeLocationAddressFaxNumber": "770-478-8722",
    "EnumerationDate": "11/15/2016",
    "LastUpdateDate": "02/12/2019",
    "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": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "508802",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LPC007651",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "LPC007651",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}