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1477006021 NPI number — OCEANSIDE FAMILY COUNSELING AND RESOURCE CENTER, PLLC

NPI Number: 1477006021
Health Care Provider/Practitioner: OCEANSIDE FAMILY COUNSELING AND RESOURCE CENTER, PLLC

Information about “1477006021” NPI (OCEANSIDE FAMILY COUNSELING AND RESOURCE CENTER, PLLC) exists in 1477006021 in HTML format HTML  |  1477006021 in plain Text format TXT  |  1477006021 in PDF (Portable Document Format) PDF  |  1477006021 in an XML format XML  formats.

NPI Number : 1477006021 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477006021",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "OCEANSIDE FAMILY COUNSELING AND RESOURCE CENTER, PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "710 SUNSET BLVD N STE D",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SUNSET BEACH",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28468-4340",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "910-575-4200",
    "MailingAddressFaxNumber": "910-575-4201",
    "FirstLinePracticeLocationAddress": "104 SUMMER LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WHITEVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28472-8757",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-234-2824",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/01/2016",
    "LastUpdateDate": "07/02/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BROWN-JOHNSON",
    "AuthorizedOfficialFirstName": "DEANNA",
    "AuthorizedOfficialMiddleName": "LYNN",
    "AuthorizedOfficialTitle": "DIRECTOR, OWNER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LPCAI LCASA",
    "AuthorizedOfficialTelephoneNumber": "910-234-2824",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "20495",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "A11182",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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