# CREATIVE JOURNEY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376191643
- **Authorized official:** SHANIA WILFONG LCSW (OWNER)
- **Authorized official phone:** (702) 527-2873

## Contact information

- **Practice address:** 9414 W LAKE MEAD BLVD, LAS VEGAS, NV 89134-8312
- **Practice address phone:** (702) 527-2873
- **Mailing address:** 6440 SKY POINTE DR STE 140328, LAS VEGAS, NV 89131-4047
- **Mailing address phone:** (702) 527-2873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 08/29/2019
- **Last updated:** 08/29/2019