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1497360465 NPI number — CONQUERING OBSTACLES WITH AMBITIOUS COMMITMENT & HEALING, LLC

NPI Number: 1497360465
Health Care Provider/Practitioner: CONQUERING OBSTACLES WITH AMBITIOUS COMMITMENT & HEALING, LLC

Information about “1497360465” NPI (CONQUERING OBSTACLES WITH AMBITIOUS COMMITMENT & HEALING, LLC) exists in 1497360465 in HTML format HTML  |  1497360465 in plain Text format TXT  |  1497360465 in PDF (Portable Document Format) PDF  |  1497360465 in an XML format XML  formats.

NPI Number : 1497360465 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497360465",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CONQUERING OBSTACLES WITH AMBITIOUS COMMITMENT & HEALING, 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": "1216 GRANBY ST STE 206",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORFOLK",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23510-2622",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-550-1594",
    "MailingAddressFaxNumber": "757-578-8244",
    "FirstLinePracticeLocationAddress": "2005 OLD GREENBRIER RD STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESAPEAKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23320-2649",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-550-1594",
    "PracticeLocationAddressFaxNumber": "757-578-8244",
    "EnumerationDate": "09/15/2020",
    "LastUpdateDate": "08/07/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SIMMONS",
    "AuthorizedOfficialFirstName": "SHANA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO/CLINICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "757-701-0762",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "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."
      }
    }
  }
}
                
            

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