{
"Npi": {
"NPI": "1932447281",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CORNERSTONE COUNSELING CENTER, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1890 S 14TH ST",
"SecondLineMailingAddress": "SUITE 303",
"MailingAddressCityName": "FERNANDINA BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32034-4740",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-206-4411",
"MailingAddressFaxNumber": "904-206-4433",
"FirstLinePracticeLocationAddress": "1890 S 14TH ST",
"SecondLinePracticeLocationAddress": "SUITE 303",
"PracticeLocationAddressCityName": "FERNANDINA BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32034-4740",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-206-4411",
"PracticeLocationAddressFaxNumber": "904-206-4433",
"EnumerationDate": "01/22/2013",
"LastUpdateDate": "01/22/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHUNN",
"AuthorizedOfficialFirstName": "SHARON",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD.",
"AuthorizedOfficialTelephoneNumber": "904-206-4411",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "LMHC7684",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}