{
"Npi": {
"NPI": "1285538330",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GARD THERAPEUTIC SERVICES PLLC",
"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": "497 CRAWFORD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STATESVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28625-8545",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "980-453-0090",
"MailingAddressFaxNumber": "704-272-3056",
"FirstLinePracticeLocationAddress": "218 W BROAD ST STE 20",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STATESVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28677-5258",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "980-453-0090",
"PracticeLocationAddressFaxNumber": "704-272-3056",
"EnumerationDate": "10/05/2026",
"LastUpdateDate": "10/05/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COOKE",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCMHC-A, LCAS-A",
"AuthorizedOfficialTelephoneNumber": "704-380-3419",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}