{"npi":"1407090707","type":"NPI-2","status":"active","name":{"display":"Southeast Psychological Services PLLC","other":[],"organization_name":"SOUTHEAST PSYCHOLOGICAL SERVICES PLLC","authorised_official":"Janet Iyoob"},"specialty":{"primary_taxonomy":"103TC0700X","primary_taxonomy_description":"Clinical Psychologist","slug":"clinical-psychologist","schema_org_specialty":null,"all":[{"code":"103TC0700X","description":"Clinical Psychologist","primary":true,"state":"NC","license":"5021"}]},"addresses":[{"purpose":"LOCATION","street_1":"8840 BLAKENEY PROFESSIONAL DR","city":"CHARLOTTE","state":"NC","postal_code":"282776718","country_code":"US","street_2":"SUITE 200","phone":"7045520116","fax":"7045527550"},{"purpose":"MAILING","street_1":"6115 PARK SOUTH DR","city":"CHARLOTTE","state":"NC","postal_code":"282103269","country_code":"US","street_2":"SUITE 130","phone":"7045520116","fax":"7045527550"}],"license":{"state":"NC","number":"5021"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"6005111","state":"NC","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2009-04-30","last_updated":"2009-04-30","_meta":{"source":"NPPES","snapshot_date":"2009-04-30","doc_url":"https://findmynpi.com/api"}}