Provider Demographics
NPI:1639822836
Name:CREATIVE JOURNEY UNITED LLC
Entity Type:Organization
Organization Name:CREATIVE JOURNEY UNITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LOREAL
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ED, MA, BSW
Authorized Official - Phone:910-975-4609
Mailing Address - Street 1:478 GREEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-7850
Mailing Address - Country:US
Mailing Address - Phone:910-817-9021
Mailing Address - Fax:910-817-9092
Practice Address - Street 1:478 GREEN LAKE RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-7850
Practice Address - Country:US
Practice Address - Phone:910-817-9021
Practice Address - Fax:910-817-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children