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1588154918 NPI number — JESSICA MARIE GILBREATH MS, LCAS, CSI

NPI Number: 1588154918
Health Care Provider/Practitioner: JESSICA MARIE GILBREATH MS, LCAS, CSI

Information about “1588154918” NPI (JESSICA MARIE GILBREATH MS, LCAS, CSI) exists in 1588154918 in HTML format HTML  |  1588154918 in plain Text format TXT  |  1588154918 in PDF (Portable Document Format) PDF  |  1588154918 in an XML format XML  formats.

NPI Number : 1588154918 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588154918",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GILBREATH",
    "FirstName": "JESSICA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, LCAS, CSI",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4597 VIRSALLI LOOP",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOPE MILLS",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28348-9430",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2200 CLYBORN CHURCH RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LUMBERTON",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28360",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-476-6779",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/10/2018",
    "LastUpdateDate": "06/06/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "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": "3247",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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