{
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"FirstLineMailingAddress": "16507 NORTHCROSS DR STE A",
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"MailingAddressCityName": "HUNTERSVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28078-5082",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-305-8026",
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"FirstLinePracticeLocationAddress": "16507 NORTHCROSS DR STE A",
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"PracticeLocationAddressFaxNumber": "425-696-2262",
"EnumerationDate": "10/03/2014",
"LastUpdateDate": "06/29/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COOPER",
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"AuthorizedOfficialCredential": "MA, LPCA",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Professional Counselor",
"LicenseNumber": "A9259",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}