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Organization
ROAD TO SUCCESS
Active
Organization
ROAD TO SUCCESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULETT CHAVERS LPC (VP)
(912) 423-0498
Entity
Organization
Contact information
Practice address
305 W SPRING ST, MOUNT VERNON, GA 30445-2837
(912) 423-0498
(912) 583-0115
Mailing address
305 W SPRING ST, MOUNT VERNON, GA 30445-2837
(912) 423-0498
(912) 583-0115
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC007564
GA
101YP2500X
Professional Counselor
Primary
LPC007564
GA
251S00000X
Community/Behavioral Health Agency
LPC007564
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003155049B
—
GA
Enumeration date
05/17/2016
Last updated
05/17/2016
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