NPI Code Detail JSON Logo

1972361269 NPI number — OPERATION STREET HARVEST, INC. DBA GA BLACK LICENSED ASSOC. COUNSELORS

NPI Number: 1972361269
Health Care Provider/Practitioner: OPERATION STREET HARVEST, INC. DBA GA BLACK LICENSED ASSOC. COUNSELORS

Information about “1972361269” NPI (OPERATION STREET HARVEST, INC. DBA GA BLACK LICENSED ASSOC. COUNSELORS) exists in 1972361269 in HTML format HTML  |  1972361269 in plain Text format TXT  |  1972361269 in PDF (Portable Document Format) PDF  |  1972361269 in an XML format XML  formats.

NPI Number : 1972361269 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972361269",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "OPERATION STREET HARVEST, INC. DBA GA BLACK LICENSED ASSOC. COUNSELORS",
    "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": "3982 MISTY LK",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ELLENWOOD",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30294-1164",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-978-9391",
    "MailingAddressFaxNumber": "770-538-1716",
    "FirstLinePracticeLocationAddress": "1 W COURT SQ STE 750",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DECATUR",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30030-2538",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-978-9391",
    "PracticeLocationAddressFaxNumber": "770-538-1716",
    "EnumerationDate": "03/11/2024",
    "LastUpdateDate": "03/28/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SUMNER BROWN",
    "AuthorizedOfficialFirstName": "TONYA",
    "AuthorizedOfficialMiddleName": "LYNN",
    "AuthorizedOfficialTitle": "CEO/CLINICAL SUPERVISOR/PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PYSD., LPC, M.DIV.",
    "AuthorizedOfficialTelephoneNumber": "678-978-9391",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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