Healthcare Provider Details

I. General information

NPI: 1740883610
Provider Name (Legal Business Name): INNER JOURNEY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TURNER PL
PISCATAWAY NJ
08854-3838
US

IV. Provider business mailing address

15 TURNER PL
PISCATAWAY NJ
08854-3838
US

V. Phone/Fax

Practice location:
  • Phone: 551-655-1563
  • Fax:
Mailing address:
  • Phone: 551-655-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARA BICKAR
Title or Position: OWNER
Credential: LPC
Phone: 551-655-1563