MEDICARE: INTOWN COUNSELING & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1528406634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTOWN COUNSELING & WELLNESS

Provider Business Mailing Address
First Line	:	27 ROCKLAND PL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 ZONOLITE RD NE
Second Line	:	STE 1A
City	:	ATLANTA
State	:	GA
Zip	:	30306-2013
Country	:	US
Telephone Number	:	404-478-9890
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT J LEENAN
Credential	:	LPC
Telephone Number	:	404-478-9890

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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