Club Success

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

CLUB SUCCESS

Practice address

6004 Nuthatch CT
Charlotte, NC 28277-5524

Phone

(980) 213-6400

NPI assigned

Mar 18, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Balrie Parks, M.ED QMHP

Title

Executive Director

Phone

(980) 213-6400

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268870400000",
    "number": "1023332111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6004 NUTHATCH CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282775524",
            "telephone_number": "980-213-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6004 NUTHATCH CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282775524",
            "telephone_number": "980-213-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB SUCCESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-03-18",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "BALRIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "980-213-6400",
        "authorized_official_credential": "M.ED QMHP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.