Organization
ROAD TO SUCCESS
Active
Other names
RTS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THADEUS HOLLOWAY LPC (CEO/COUNSELOR)
(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, P.O. BOX 172, MOUNT VERNON, GA 30445-2837
(912) 423-0498
(912) 583-0115
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
LPC006790
GA
251S00000X
Community/Behavioral Health Agency
Primary
LPC006790
GA
252Y00000X
Early Intervention Provider Agency
LPC006790
GA
Other
Enumeration date
12/19/2014
Last updated
12/19/2014
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