Provider Demographics
NPI:1003943481
Name:BUILDING INTIMATE MARRIAGES, INC.
Entity Type:Organization
Organization Name:BUILDING INTIMATE MARRIAGES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYTSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-822-4505
Mailing Address - Street 1:1325 SATELLITE BLVD NW
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4651
Mailing Address - Country:US
Mailing Address - Phone:770-822-4505
Mailing Address - Fax:
Practice Address - Street 1:1325 SATELLITE BLVD NW
Practice Address - Street 2:SUITE 1002
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4651
Practice Address - Country:US
Practice Address - Phone:770-822-4505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1970101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty