{
"Npi": {
"NPI": "1346614690",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTEGRATIVE COUNSELING SOLUTIONS, LLC",
"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": "42161 BLACK HILLS PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STONE RIDGE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "20105-2932",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-470-1202",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4229 LAFAYETTE CENTER DR STE 1200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHANTILLY",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "20151-1265",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-470-1202",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/24/2015",
"LastUpdateDate": "11/24/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PORTO",
"AuthorizedOfficialFirstName": "ANA KARINA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "703-470-1202",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "0701006220",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}