{
"Npi": {
"NPI": "1487542585",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOUNTAINS TO LAKE COUNSELING, PLLC",
"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": "129 SEA TRAIL DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOORESVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28117-8493",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-677-5479",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "129 SEA TRAIL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOORESVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28117-8493",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-677-5479",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/26/2025",
"LastUpdateDate": "06/26/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREGA",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COUNSELOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA, LCMHC",
"AuthorizedOfficialTelephoneNumber": "704-677-5479",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}