Healthcare Provider Details

I. General information

NPI: 1518348853
Provider Name (Legal Business Name): SACRED JOURNEY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 WATERSIDE DR #2525
NORFOLK VA
23510-3300
US

IV. Provider business mailing address

999 WATERSIDE DR #2525
NORFOLK VA
23510-3300
US

V. Phone/Fax

Practice location:
  • Phone: 704-244-9069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CONNIE OMARI
Title or Position: CEO AND FOUNDER
Credential: PHD
Phone: 704-244-9069