{
"Npi": {
"NPI": "1316826589",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "THOMAS",
"FirstName": "JENNIFER",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LPN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "THOMAS",
"OtherFirstName": "JENNIFER",
"OtherMiddleName": "KIRKLEY",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LPN",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "14250 N FRASER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GEORGETOWN",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29440-9271",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-359-7509",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1341 N CASHUA DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLORENCE",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29501-6939",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-673-9320",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/01/2025",
"LastUpdateDate": "09/01/2025",
"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": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "P42416",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}