{
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"OrgName": "MECHELE DE AVILA, LCSW, LLC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 41001",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BATON ROUGE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70835",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-366-8606",
"MailingAddressFaxNumber": "225-410-0080",
"FirstLinePracticeLocationAddress": "1082 HAVENWOOD DRIVE",
"SecondLinePracticeLocationAddress": "BACK APARTMENT",
"PracticeLocationAddressCityName": "BATON ROUGE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "225-366-8606",
"PracticeLocationAddressFaxNumber": "225-410-0080",
"EnumerationDate": "05/16/2013",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EVANS",
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"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "504-453-0216",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Behavioral Health Agency",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}