{
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"FirstLineMailingAddress": "4964 GREENLAND HIDEAWAY DR N",
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"FirstLinePracticeLocationAddress": "4964 GREENLAND HIDEAWAY DR N",
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"EnumerationDate": "02/21/2022",
"LastUpdateDate": "02/21/2022",
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"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILLER",
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"AuthorizedOfficialCredential": "LCSW",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}