Healthcare Provider Details

I. General information

NPI: 1700709250
Provider Name (Legal Business Name): INTENTIONALLY RECONNECTING HEARTS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHAMBLEE TUCKER RD STE 201
CHAMBLEE GA
30341-4100
US

IV. Provider business mailing address

170 SHOALS CREEK RD
COVINGTON GA
30016-4198
US

V. Phone/Fax

Practice location:
  • Phone: 678-886-3325
  • Fax:
Mailing address:
  • Phone: 678-886-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SOCROTIFF MICHAEL
Title or Position: CEO/FOUNDER
Credential: LPC, LMFT
Phone: 678-886-3325