{
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"FirstLineMailingAddress": "810 BLUE RIDGE AVE",
"SecondLineMailingAddress": "SUITE A",
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"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24523-2433",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "540-587-5853",
"FirstLinePracticeLocationAddress": "810 BLUE RIDGE AVE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-587-5852",
"PracticeLocationAddressFaxNumber": "540-587-5853",
"EnumerationDate": "05/14/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRYANT",
"AuthorizedOfficialFirstName": "PATRICIA",
"AuthorizedOfficialMiddleName": "RAE",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW, RN, CS",
"AuthorizedOfficialTelephoneNumber": "540-587-5852",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "0904003951",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}