{
"Npi": {
"NPI": "1518408236",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DOLLING",
"FirstName": "SAMUEL",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": "JR.",
"Credential": "M.M., L.A.C.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8801 LIPAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THORNTON",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80260-4912",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9025 GRANT ST STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THORNTON",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80229-4362",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-412-3656",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/14/2017",
"LastUpdateDate": "03/14/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "ACD.0000753",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}