Provider Demographics
NPI:1326446659
Name:ROAD TO SUCCESS
Entity Type:Organization
Organization Name:ROAD TO SUCCESS
Other - Org Name:RTS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THADEUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-423-0498
Mailing Address - Street 1:305 W SPRING ST
Mailing Address - Street 2:P.O. BOX 172
Mailing Address - City:MOUNT VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445-2837
Mailing Address - Country:US
Mailing Address - Phone:912-423-0498
Mailing Address - Fax:912-583-0115
Practice Address - Street 1:305 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:GA
Practice Address - Zip Code:30445-2837
Practice Address - Country:US
Practice Address - Phone:912-423-0498
Practice Address - Fax:912-583-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006790251B00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency