{
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"FirstLineMailingAddress": "2217 PRINCESS ANNE STREET SUITE",
"SecondLineMailingAddress": "204-1",
"MailingAddressCityName": "FREDERICKSBURG",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-940-2858",
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"FirstLinePracticeLocationAddress": "2217 PRINCESS ANNE ST",
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"EnumerationDate": "03/09/2015",
"LastUpdateDate": "03/09/2015",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLACK",
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"AuthorizedOfficialCredential": "M. ED. , BCBA",
"AuthorizedOfficialTelephoneNumber": "540-842-3331",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Behavioral Health Agency",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}