{
"Npi": {
"NPI": "1932129517",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BALLENGER",
"FirstName": "CHRISTINE",
"MiddleName": "ASHLEY",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSY.D., LPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KISTLER",
"OtherFirstName": "CHRISTINE",
"OtherMiddleName": "ASHLEY",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "PSY.D., LPC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "106 CHESTER STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRONT ROYAL",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22630-3323",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-252-2654",
"MailingAddressFaxNumber": "855-529-4516",
"FirstLinePracticeLocationAddress": "106 CHESTER STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FRONT ROYAL",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22630-3323",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-252-2654",
"PracticeLocationAddressFaxNumber": "855-529-4516",
"EnumerationDate": "07/19/2006",
"LastUpdateDate": "11/02/2023",
"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": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "0810005807",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "0810005807",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}