{
"Npi": {
"NPI": "1548656622",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WITHERS",
"FirstName": "RANDAL",
"MiddleName": "WAYNE",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "NCC LCMHC LCAS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "104 N GREEN ST UNIT 148",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MORGANTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28655-3422",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "282-012-7788",
"MailingAddressFaxNumber": "828-282-0899",
"FirstLinePracticeLocationAddress": "715 FAIRGROVE CHURCH RD SE STE 202",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CONOVER",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28613-9289",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "828-201-2778",
"PracticeLocationAddressFaxNumber": "828-282-0899",
"EnumerationDate": "04/15/2015",
"LastUpdateDate": "05/19/2025",
"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": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "11110",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}