{
"Npi": {
"NPI": "1316637440",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRIDGES",
"FirstName": "OLIVIA",
"MiddleName": "DIANE",
"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": "905 HALSTEAD BLVD STE 14-15",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELIZABETH CITY",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27909-6986",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-698-1393",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "905 HALSTEAD BLVD STE 15",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ELIZABETH CITY",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27909-6816",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-379-1712",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/11/2023",
"LastUpdateDate": "06/13/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "P016851",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}