MEDICARE: SRJ CREATIVE ENDEAVORS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1811674088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRJ CREATIVE ENDEAVORS, LLC

Provider Business Mailing Address
First Line	:	2764 PLEASANT RD STE A #10321
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708
Country	:	US
Telephone Number	:	803-820-9185
Fax Number	:

Provider Business Practice Location Address
First Line	:	4607 CHARLOTTE HWY STE 2
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8147
Country	:	US
Telephone Number	:	803-820-9185
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE JOHNSON
Credential	:	LMT
Telephone Number	:	803-820-9185

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

Similar Medicare Providers

1730824988 — JULIE L DUDLEY
Practice Location Address:

4607 CHARLOTTE HWY STE 5
LAKE WYLIE, SC
29710-8147

Practice Phone: 704-891-2359
Practice Fax: 704-900-7890

1851585186 — MRS. KIMBERLY BUDAY D.O., M.P.H.
Practice Location Address:

9036 E M 36
WHITMORE LAKE, MI
48189-8147

Practice Phone: 734-449-3925
Practice Fax:

1588980981 — MRS. CINDY DIANE WALKER SLP
Practice Location Address:

8147 SHADOW LAKE DR
BLANCHARD, OK
73010-4002

Practice Phone: 405-245-6190
Practice Fax:

1619648508 — KAMAL KAUR
Practice Location Address:

9036 E MI STATE ROAD 36
WHITMORE LAKE, MI
48189-8147

Practice Phone: 734-449-3320
Practice Fax:

1225724156 — MENGYUAN CHE
Practice Location Address:

9036 E M 36
WHITMORE LAKE, MI
48189-8147

Practice Phone: 734-449-3320
Practice Fax: 888-976-6019

1336901362 — MRS. SUZETTE MOLLENIDO SUAREZ NURSE PRACTITIONER
Practice Location Address:

4011 LAKE RUSSELL DR
FLORENCE, SC
29501-8147

Practice Phone: 843-861-2120
Practice Fax:

Directions to “SRJ CREATIVE ENDEAVORS, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.