=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992616932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE INTIMACY EXPERIENCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 997 COMMERCE DR SW STE 3F
-----------------------------------------------------
City | CONYERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30094-6647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-648-4948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 997 COMMERCE DR SW STE 3F
-----------------------------------------------------
City | CONYERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30094-6647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-648-4948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMFT, CST
-----------------------------------------------------
Name | ERICA HARRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-648-4948
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------