{
"Npi": {
"NPI": "1841203338",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GRANT",
"FirstName": "CORINE",
"MiddleName": "DODGE",
"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": "609 BIRKDALE CIR W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NICEVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32578-4303",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-897-6911",
"MailingAddressFaxNumber": "850-729-5022",
"FirstLinePracticeLocationAddress": "1813 JOHN SIMS PKWY E",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "NICEVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32578-2337",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-729-5009",
"PracticeLocationAddressFaxNumber": "850-729-5022",
"EnumerationDate": "08/14/2006",
"LastUpdateDate": "07/08/2007",
"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": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "4826",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}