NPIMap

Organization Active NPI

Road to Success

  • Professional Counselor
  • Mount Vernon, GA
National Provider Identifier
1205283520
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC007564 Issued in GA
Legal business name
ROAD TO SUCCESS
Practice address
305 W Spring St
Mount Vernon, GA 30445-2837
Phone
(912) 423-0498
Fax
(912) 583-0115
NPI assigned
May 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2016

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

Authorized official

Name
Paulett Chavers, LPC
Title
VP
Phone
(912) 423-0498

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X LPC007564 GA
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X LPC007564 GA Primary
Community/Behavioral Health Agency 251S00000X LPC007564 GA

Addresses

Primary practice location

305 W Spring St
Mount Vernon, GA 30445-2837

Mailing address

305 W Spring St
Mount Vernon, GA 30445-2837
Phone (912) 423-0498

Other identifiers 1

IdentifierTypeStateIssuer
003155049BMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Road to Success2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

305 W Spring St
Mount Vernon, GA 30445
Phone (912) 423-0498

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463443200000",
    "number": "1205283520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W SPRING ST",
            "city": "MOUNT VERNON",
            "state": "GA",
            "postal_code": "304452837",
            "telephone_number": "912-423-0498",
            "fax_number": "912-583-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W SPRING ST",
            "city": "MOUNT VERNON",
            "state": "GA",
            "postal_code": "304452837",
            "telephone_number": "912-423-0498",
            "fax_number": "912-583-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROAD TO SUCCESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-17",
        "last_updated": "2016-05-17",
        "status": "A",
        "authorized_official_last_name": "CHAVERS",
        "authorized_official_first_name": "PAULETT",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "912-423-0498",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "GA",
            "license": "LPC007564",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC007564",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC007564",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003155049B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; 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.