{
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"FirstLineMailingAddress": "2003 GODWIN AVE STE B",
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"MailingAddressCityName": "LUMBERTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28358-3150",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-671-1111",
"MailingAddressFaxNumber": "910-671-4454",
"FirstLinePracticeLocationAddress": "104 INDUSTRIAL PARK ROAD",
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"PracticeLocationAddressCityName": "TABOR CITY",
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"PracticeLocationAddressTelephoneNumber": "910-653-3040",
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"EnumerationDate": "12/23/2009",
"LastUpdateDate": "03/22/2010",
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"Gender": null,
"AuthorizedOfficialLastName": "AUGUSTINE",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "910-733-2007",
"Taxonomies": {
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"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "MHL 024 082",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}