{
"Npi": {
"NPI": "1467990846",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHEAST COUNSELING ASSOCIATES, 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": "39 HAVERHILL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "METHUEN",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01844-4203",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "978-804-4068",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "39 HAVERHILL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "METHUEN",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01844-4203",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "978-804-4068",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/06/2017",
"LastUpdateDate": "02/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALLACE",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "OWNER/PSYCHOTHERAPIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSW, LICSW",
"AuthorizedOfficialTelephoneNumber": "978-804-4068",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "116999",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}