{
"Npi": {
"NPI": "1316545833",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ADDISON",
"FirstName": "JESSICA",
"MiddleName": "FAITH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "AMFT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "609 NEWNAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARROLLTON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30117-3428",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-210-1716",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "CLARITY COUNSELING OF WEST GEORGIA",
"SecondLinePracticeLocationAddress": "609 NEWNAN ST",
"PracticeLocationAddressCityName": "CARROLLTON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30117",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-210-1716",
"PracticeLocationAddressFaxNumber": "317-520-8200",
"EnumerationDate": "10/16/2020",
"LastUpdateDate": "02/05/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "01/09/2026",
"NPIReactivationDate": "02/04/2026",
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "AMFT000917",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}