The Intimacy Center of Georgia

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT001585 Issued in GA

Legal business name

THE INTIMACY CENTER OF GEORGIA

Practice address

3400 Chapel Hill Rd Ste 317
Douglasville, GA 30135-1739

Phone

(678) 750-3952

Fax

(678) 838-4595

NPI assigned

Aug 31, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephanie WalthourNPI 1659816288

Title

Clinical Director

Phone

(678) 750-3952

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephanie Walthour, LMFT

  • Marriage & Family Therapist
  • Douglasville, GA
  • NPI 1659816288
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1922580448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CHAPEL HILL RD STE 317",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351739",
            "telephone_number": "678-750-3952",
            "fax_number": "678-838-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CHAPEL HILL RD STE 317",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351739",
            "telephone_number": "678-750-3952",
            "fax_number": "678-838-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE INTIMACY CENTER OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-31",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "WALTHOUR",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "678-750-3952"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT001585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Marriage & Family Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.