{
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"OrgName": "CENTER FOR WELLNESS: COMMUNITY COUNSELING, INC",
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"FirstLineMailingAddress": "4452 KINGS HWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOUGLASVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30135-4604",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-597-1147",
"MailingAddressFaxNumber": "770-693-8619",
"FirstLinePracticeLocationAddress": "8333 OFFICE PARK DR",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "DOUGLASVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-597-1147",
"PracticeLocationAddressFaxNumber": "770-693-8619",
"EnumerationDate": "08/06/2008",
"LastUpdateDate": "08/06/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHEELER",
"AuthorizedOfficialFirstName": "CAROL",
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"AuthorizedOfficialTitle": "PRESIDENT/THERAPIST",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "770-597-1147",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "CSW 002206",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}