Provider Demographics
NPI:1548608656
Name:LEENAN, SCOTT JAMES (LPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JAMES
Last Name:LEENAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ROCKLAND PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 ZONOLITE RD NE
Practice Address - Street 2:STE 1A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2013
Practice Address - Country:US
Practice Address - Phone:404-478-9890
Practice Address - Fax:404-963-0975
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional