{
"Npi": {
"NPI": "1639516032",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROAD TO WELLNESS, LLC",
"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": "2911 DIXWELL AVE",
"SecondLineMailingAddress": "SUITE B-5",
"MailingAddressCityName": "HAMDEN",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06518-3195",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-654-1367",
"MailingAddressFaxNumber": "203-889-4926",
"FirstLinePracticeLocationAddress": "2911 DIXWELL AVE",
"SecondLinePracticeLocationAddress": "SUITE B-5",
"PracticeLocationAddressCityName": "HAMDEN",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06518-3195",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-654-1367",
"PracticeLocationAddressFaxNumber": "203-889-4926",
"EnumerationDate": "05/27/2013",
"LastUpdateDate": "05/27/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRIER-ROGERS",
"AuthorizedOfficialFirstName": "ALEESHA",
"AuthorizedOfficialMiddleName": "DENISE",
"AuthorizedOfficialTitle": "MANAGER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSY.D.",
"AuthorizedOfficialTelephoneNumber": "203-654-1367",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "003271",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}