{
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"FirstLineMailingAddress": "6802 PARAGON PL",
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"MailingAddressStateName": "VA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6802 PARAGON PL",
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"EnumerationDate": "06/02/2022",
"LastUpdateDate": "06/02/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FALTZ",
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"AuthorizedOfficialCredential": "SERVICE FACILITATOR",
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"TaxonomyName": "Case Management Agency",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}