Team Success LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-018-086 Issued in NC

Legal business name

TEAM SUCCESS LLC

Doing business as

Team Success Youth Home

Practice address

3393 Startown Rd
Newton, NC 28658-9216

Phone

(704) 668-3573

NPI assigned

Oct 15, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Dwayne Anthony Herbert, BBA, MBA

Title

Executive Director

Phone

(704) 668-3573

Specialties & licenses 1

Addresses

Other names 1

• Team Success Youth Home Doing business as

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1831341429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 N HIGHWAY 16",
            "address_2": "APT. 14",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280375004",
            "telephone_number": "704-668-3573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3393 STARTOWN RD",
            "city": "NEWTON",
            "state": "NC",
            "postal_code": "286589216",
            "telephone_number": "704-668-3573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEAM SUCCESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-15",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "HERBERT",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-668-3573",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BBA, MBA"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-018-086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Team Success Youth Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Vernice Stevenson, PT, DPT
• Sarah Jane Stewart, DO
• Kelly Jo Stockton-Drum, ANP-C,GNP
• Alan Wade Story, M.D.
• Michelle Sullivan, LMFT
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• The Tamarisk Place, Inc.
• Brittany Davis Tidd, PNP

• Emotionally Disturbed Childrens' Residential Treatment Facility in Newton, NC
• Providers in Newton, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; 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.