{
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"FirstLineMailingAddress": "304 W MILLBROOK RD",
"SecondLineMailingAddress": "SUITE F",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "919-329-2631",
"FirstLinePracticeLocationAddress": "304 W MILLBROOK RD",
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"PracticeLocationAddressFaxNumber": "919-329-2631",
"EnumerationDate": "05/23/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIRK",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "919-696-6071",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Mental Health Counselor",
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"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}