{
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"FirstLineMailingAddress": "3520 PRITCHARD CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RALEIGH",
"MailingAddressStateName": "NC",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-602-8572",
"MailingAddressFaxNumber": "919-747-4172",
"FirstLinePracticeLocationAddress": "8510 SIX FORKS RD STE 101",
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"PracticeLocationAddressCityName": "RALEIGH",
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"PracticeLocationAddressFaxNumber": "919-747-4172",
"EnumerationDate": "09/08/2010",
"LastUpdateDate": "09/08/2010",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "POLOMIK",
"AuthorizedOfficialFirstName": "ELIZABETH",
"AuthorizedOfficialMiddleName": "MARIE",
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"AuthorizedOfficialCredential": "LPC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Mental Health Counselor",
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"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}