Provider Demographics
NPI:1558859264
Name:CREATE A JOURNEY, LLC
Entity Type:Organization
Organization Name:CREATE A JOURNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-1145
Mailing Address - Street 1:4924 WINDY HILL DR STE A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4930
Mailing Address - Country:US
Mailing Address - Phone:919-855-1145
Mailing Address - Fax:302-729-0988
Practice Address - Street 1:4924 WINDY HILL DR STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4930
Practice Address - Country:US
Practice Address - Phone:919-855-1145
Practice Address - Fax:302-729-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty