{
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"FirstLineMailingAddress": "44 N POTOMAC ST STE 103",
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"EnumerationDate": "06/14/2016",
"LastUpdateDate": "07/08/2022",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "DOUGLAS",
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"AuthorizedOfficialCredential": "LCSW-C",
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}
},
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}
}
}
}