{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "DECATUR RECOVERY SERVICES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 2549",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DECATUR",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30031-2549",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-378-4167",
"MailingAddressFaxNumber": "404-378-2102",
"FirstLinePracticeLocationAddress": "558 MEDLOCK RD",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "DECATUR",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30030-1512",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-378-4167",
"PracticeLocationAddressFaxNumber": "404-378-2102",
"EnumerationDate": "02/15/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUGHES",
"AuthorizedOfficialFirstName": "MARILYN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PSYCHOTHERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.P.C.",
"AuthorizedOfficialTelephoneNumber": "404-378-4167",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "1844",
"LicenseNumberStateCode": "GA",
"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."
}
}
}
}