{
"Npi": {
"NPI": "1689862294",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARSK",
"FirstName": "ANGELA",
"MiddleName": "GRACE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LESLIE",
"OtherFirstName": "ANGELA",
"OtherMiddleName": "GRACE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "LCSWA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "913 N CAROLINA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STATESVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28677-3414",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-873-1114",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "913 N CAROLINA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STATESVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28677-3414",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-873-1114",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/09/2007",
"LastUpdateDate": "06/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}