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General NPI Number Information
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NPI Number | 1619125655
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Entity Type | Organization
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Legal Business Name | INTOWN PSYCHOLOGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 04/02/2010
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Provider Practice Location Address
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Address Line | 501 PULLIAM ST SW STE 407
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City | ATLANTA
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State | GA
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Zip | 30312-2755
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Country | US
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Telephone | 404-474-7021
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Fax |
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Provider Business Mailing Address
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Address Line | 501 PULLIAM ST SW STE 407
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City | ATLANTA
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State | GA
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Zip | 30312-2755
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Country | US
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Telephone | 404-474-7021
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Fax | 404-592-4698
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Authorized Official
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Title or Position | OFFICE ADM
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Name | MR. SCOTT J LEENAN
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Credential |
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Telephone | 404-474-7021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY001580
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License Number State | GA
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