{
"Npi": {
"NPI": "1386071033",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FINE",
"FirstName": "THOMAS",
"MiddleName": "EDWARD CHRISTOPHER",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "QP, MA, LPCA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FINE",
"OtherFirstName": "CHRIS",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "QP, MA, LPCA",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "3000 SPANISH CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RALEIGH",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27607-0054",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-404-4039",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3900 BARRETT DR STE 208",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RALEIGH",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27609-6614",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-907-0597",
"PracticeLocationAddressFaxNumber": "919-907-0597",
"EnumerationDate": "09/26/2013",
"LastUpdateDate": "03/01/2019",
"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": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "A12275",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}