{
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"FirstLineMailingAddress": "10031 PINES BLVD STE 242",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PEMBROKE PINES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33024-6180",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-438-5661",
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"FirstLinePracticeLocationAddress": "10031 PINES BLVD STE 242",
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"PracticeLocationAddressTelephoneNumber": "954-438-5661",
"PracticeLocationAddressFaxNumber": "954-333-7694",
"EnumerationDate": "02/24/2012",
"LastUpdateDate": "02/24/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "RICKETTS",
"AuthorizedOfficialFirstName": "PERCIVAL",
"AuthorizedOfficialMiddleName": "GEORGE",
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"AuthorizedOfficialCredential": "EDD, LMHC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Mental Health Counselor",
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"LicenseNumberStateCode": "FL",
"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."
}
}
}
}