{
"Npi": {
"NPI": "1902450737",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE JOURNEY BEHAVIORAL AND WELLNESS CLINIC, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5825 CASTLECOVE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28273-0500",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-687-6768",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1456 EBENEZER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROCK HILL",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29732-2339",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-693-6100",
"PracticeLocationAddressFaxNumber": "803-746-0923",
"EnumerationDate": "07/30/2019",
"LastUpdateDate": "10/15/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STUTTS",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "TURBEVILLE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "FNP-BC, APRN",
"AuthorizedOfficialTelephoneNumber": "843-687-6768",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}