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1326414731 NPI number — DONTAE ANTUAN DONNELL SR. LPCA, LCASA

NPI Number: 1326414731
Health Care Provider/Practitioner: DONTAE ANTUAN DONNELL SR. LPCA, LCASA

Information about “1326414731” NPI (DONTAE ANTUAN DONNELL SR. LPCA, LCASA) exists in 1326414731 in HTML format HTML  |  1326414731 in plain Text format TXT  |  1326414731 in PDF (Portable Document Format) PDF  |  1326414731 in an XML format XML  formats.

NPI Number : 1326414731 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326414731",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DONNELL",
    "FirstName": "DONTAE",
    "MiddleName": "ANTUAN",
    "NamePrefix": "MR.",
    "NameSuffix": "SR.",
    "Credential": "LPCA, LCASA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DONNELL",
    "OtherFirstName": "DONTAE",
    "OtherMiddleName": "ANTUAN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": "I",
    "OtherCredential": "LPCA, LCASA",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "4425 GRAY WOLF WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENSBORO",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27406-8260",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "336-405-7343",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1451 S ELM EUGENE ST # 3112",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENSBORO",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27406-2200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-844-5322",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/19/2015",
    "LastUpdateDate": "11/05/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "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": "21953",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "11737",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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