Creative Journey United LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

CREATIVE JOURNEY UNITED LLC

Practice address

478 Green Lake Rd
Rockingham, NC 28379-7850

Phone

(910) 817-9021

Fax

(910) 817-9092

NPI assigned

Jan 28, 2022

Last updated

Feb 4, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brenda Loreal Dumas, PH.D., ED., MA, BSW

Title

Chief Executive Officer

Phone

(910) 975-4609

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1639822836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "478 GREEN LAKE RD",
            "city": "ROCKINGHAM",
            "state": "NC",
            "postal_code": "283797850",
            "telephone_number": "910-817-9021",
            "fax_number": "910-817-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 GREEN LAKE RD",
            "city": "ROCKINGHAM",
            "state": "NC",
            "postal_code": "283797850",
            "telephone_number": "910-817-9021",
            "fax_number": "910-817-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE JOURNEY UNITED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "DUMAS",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LOREAL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "910-975-4609",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., ED., MA, BSW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "USB",
            "affiliation": "N",
            "endpointDescription": "Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "EMAIL",
            "address_1": "478 Green Lake Rd",
            "city": "Rockingham",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283797850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.