Healthcare Provider Details

I. General information

NPI: 1992616932
Provider Name (Legal Business Name): THE INTIMACY EXPERIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 COMMERCE DR SW STE 3F
CONYERS GA
30094-6647
US

IV. Provider business mailing address

997 COMMERCE DR SW STE 3F
CONYERS GA
30094-6647
US

V. Phone/Fax

Practice location:
  • Phone: 770-648-4948
  • Fax:
Mailing address:
  • Phone: 770-648-4948
  • 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: ERICA HARRY
Title or Position: LMFT, CST
Credential:
Phone: 770-648-4948