{
"Npi": {
"NPI": "1548497696",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BEHAVIORAL COUNSELING AND INTERVENTION MANAGEMENT, 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": "787 OLD MACON RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DUBLIN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31021-0941",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-274-9003",
"MailingAddressFaxNumber": "478-275-1916",
"FirstLinePracticeLocationAddress": "511 TELFAIR ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DUBLIN",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31021-5144",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-274-9003",
"PracticeLocationAddressFaxNumber": "478-275-1916",
"EnumerationDate": "06/16/2009",
"LastUpdateDate": "06/16/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MINCEY",
"AuthorizedOfficialFirstName": "MARTHA",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "PROGRAM DIRECTOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "478-275-7854",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": "LPC003234",
"LicenseNumberStateCode": "GA",
"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."
}
}
}
}