{
"Npi": {
"NPI": "1306881057",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMMUNITY COUNSELING & MENTORING SERVICES, INC",
"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": "1300 MERCANTILE LN",
"SecondLineMailingAddress": "SUITE 208",
"MailingAddressCityName": "LARGO",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20774-5327",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-583-0001",
"MailingAddressFaxNumber": "301-583-3403",
"FirstLinePracticeLocationAddress": "1300 MERCANTILE LN",
"SecondLinePracticeLocationAddress": "SUITE 208",
"PracticeLocationAddressCityName": "LARGO",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20774-5327",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-583-0001",
"PracticeLocationAddressFaxNumber": "301-583-3403",
"EnumerationDate": "06/17/2006",
"LastUpdateDate": "12/21/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARVANA",
"AuthorizedOfficialFirstName": "ANTHONY",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PRESIDENT & CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "301-583-0001",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}