Healthcare Provider Details

I. General information

NPI: 1013831858
Provider Name (Legal Business Name): TIED2SUCCESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W STATE ST STE 1007
ROCKFORD IL
61101-1155
US

IV. Provider business mailing address

202 W STATE ST STE 1007
ROCKFORD IL
61101-1155
US

V. Phone/Fax

Practice location:
  • Phone: 224-268-2117
  • Fax:
Mailing address:
  • Phone: 224-268-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARCELLOUS POLLARDS
Title or Position: CEO
Credential: LCSW
Phone: 224-268-2117