Healthcare Provider Details

I. General information

NPI: 1215676069
Provider Name (Legal Business Name): TOTAL SUCCESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNMENT AVE SW
HICKORY NC
28602-2954
US

IV. Provider business mailing address

11633 ASBURY CHAPEL RD
HUNTERSVILLE NC
28078-4631
US

V. Phone/Fax

Practice location:
  • Phone: 704-630-2469
  • Fax:
Mailing address:
  • Phone: 704-630-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. FLEISHA SHEIVON BREWTON
Title or Position: CEO
Credential: MMPA
Phone: 704-630-2469