{
"Npi": {
"NPI": "1639709918",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KING",
"FirstName": "ANTONIO",
"MiddleName": null,
"NamePrefix": "MR.",
"NameSuffix": "JR.",
"Credential": "LSATP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "303 MEADOWLAKE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YORKTOWN",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23693-3617",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-713-0385",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "519 XENIA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DAYTON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45410-1823",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "937-589-2277",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/25/2020",
"LastUpdateDate": "09/11/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"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": "0718000615",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "0710103027",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}