{
"Npi": {
"NPI": "1649468562",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE FAMILY WELLNESS CENTER, PLLC",
"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": "7062 CHERRY RUN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WASHINGTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27889-8398",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-814-5464",
"MailingAddressFaxNumber": "252-948-3693",
"FirstLinePracticeLocationAddress": "409 W MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "WASHINGTON",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27889-4882",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-948-3692",
"PracticeLocationAddressFaxNumber": "252-948-3693",
"EnumerationDate": "10/04/2007",
"LastUpdateDate": "10/04/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BELL",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "EUGENE",
"AuthorizedOfficialTitle": "DIRECTOR/NC LICENSED MFT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "II",
"AuthorizedOfficialCredential": "M.S., LMFT",
"AuthorizedOfficialTelephoneNumber": "252-814-5464",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "1133",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}