{
"Npi": {
"NPI": "1609994649",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAITH THERAPEUTIC SERVICES, INC",
"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": "PO BOX 1936",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SWANSBORO",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28584",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-389-8830",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "411 WESTERN BLVD STE 22",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28546-6848",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-389-8830",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/27/2007",
"LastUpdateDate": "04/14/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROUSH",
"AuthorizedOfficialFirstName": "HELEN",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BA QMHP QDDP",
"AuthorizedOfficialTelephoneNumber": "910-389-8830",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "MHL-067-038",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}