MEDICARE: SACRED JOURNEY INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1518348853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED JOURNEY INC.

Provider Business Mailing Address
First Line	:	999 WATERSIDE DR
Second Line	:	#2525
City	:	NORFOLK
State	:	VA
Zip	:	23510-3300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 WATERSIDE DR
Second Line	:	#2525
City	:	NORFOLK
State	:	VA
Zip	:	23510-3300
Country	:	US
Telephone Number	:	704-244-9069
Fax Number	:

Authorized Official
Title or Position	:	CEO AND FOUNDER
Name	:	DR. CONNIE OMARI
Credential	:	PHD
Telephone Number	:	704-244-9069

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	06/12/2015

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Directions to “SACRED JOURNEY INC. ” Practice Location

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