{
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"FirstLineMailingAddress": "1332 CUSHING STREET",
"SecondLineMailingAddress": "1108 GRACADE STREET",
"MailingAddressCityName": "GREENSBORO",
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"MailingAddressPostalCode": "27408",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-383-9932",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1332 CUSHING ST",
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"PracticeLocationAddressCityName": "GREENSBORO",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressTelephoneNumber": "336-383-9932",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/31/2016",
"LastUpdateDate": "08/31/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARKE",
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"AuthorizedOfficialCredential": "MS, LPC, LCAS-A,",
"AuthorizedOfficialTelephoneNumber": "336-383-9932",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "10171",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}