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1760903918 NPI number — PROGRESSIVE LIFE CHANGERS

NPI Number: 1760903918
Health Care Provider/Practitioner: PROGRESSIVE LIFE CHANGERS

Information about “1760903918” NPI (PROGRESSIVE LIFE CHANGERS) exists in 1760903918 in HTML format HTML  |  1760903918 in plain Text format TXT  |  1760903918 in PDF (Portable Document Format) PDF  |  1760903918 in an XML format XML  formats.

NPI Number : 1760903918 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760903918",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PROGRESSIVE LIFE CHANGERS",
    "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": "1101 BELLEVIEW ST STE 103",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29201-1863",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-726-2590",
    "MailingAddressFaxNumber": "980-422-0161",
    "FirstLinePracticeLocationAddress": "1101 BELLEVIEW ST STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29201-1863",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-726-2590",
    "PracticeLocationAddressFaxNumber": "980-422-0161",
    "EnumerationDate": "06/28/2017",
    "LastUpdateDate": "05/13/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CURLEE",
    "AuthorizedOfficialFirstName": "KENNETH",
    "AuthorizedOfficialMiddleName": "O'BRYAN",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "704-726-2590",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041S0200X",
          "TaxonomyName": "School Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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