{
"Npi": {
"NPI": "1811779911",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "REINGOLD",
"FirstName": "SUSAN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "REINGOLD",
"OtherFirstName": "SHOSHI",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "185 TRUEHEDGE TRCE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROSWELL",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30076-2948",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "140-440-5242",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11111 HOUZE RD STE 225",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROSWELL",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30076-5618",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-603-0123",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/16/2023",
"LastUpdateDate": "11/22/2024",
"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": "101Y00000X",
"TaxonomyName": "Counselor",
"LicenseNumber": "APC009542",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "APC009542",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}