{
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"FirstLineMailingAddress": "13121 BROOK LANE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAGERSTOWN",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21742-1435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-733-0330",
"MailingAddressFaxNumber": "301-733-4038",
"FirstLinePracticeLocationAddress": "4540 B-D MACK AVE",
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"PracticeLocationAddressCityName": "FREDERICK",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "301-733-4038",
"EnumerationDate": "02/04/2015",
"LastUpdateDate": "10/01/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARKDOLL",
"AuthorizedOfficialFirstName": "JAMIE",
"AuthorizedOfficialMiddleName": "LEA",
"AuthorizedOfficialTitle": "CRED COORDINATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "301-733-0331",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "School Counselor",
"LicenseNumber": "4010",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
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}
}
}
}