{
"Npi": {
"NPI": "1679357602",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "EVISION MENTAL HEALTH SERVICES LLC",
"ParentOrgTIN": null,
"OrgName": "EVISION MENTAL HEALTH SERVICES 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": "4806 MANTLEWOOD WAY APT 102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ABERDEEN",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21001-3646",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-739-2084",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1515 MARTIN BLVD STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21220-4103",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-739-2048",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/21/2023",
"LastUpdateDate": "08/21/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "SHALITA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "437-739-2084",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0405X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}