# INTOWN PEDIATRIC BEHAVIORAL WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265895569
- **Authorized official:** DR. JENNIFER LYNN POULOS PSY.D. (OWNER/PEDIATRIC PSYCHOLOGIST)
- **Authorized official phone:** (770) 656-1365

## Contact information

- **Practice address:** 340 BOULEVARD NE, SUITE 345, ATLANTA, GA 30312-1273
- **Practice address phone:** (404) 653-0322
- **Practice address fax:** (404) 653-0466
- **Mailing address:** 1170 N HIGHLAND AVE NE, B10, ATLANTA, GA 30306-3400
- **Mailing address phone:** (770) 656-1365
- **Mailing address fax:** (404) 653-0466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | PSY003708 | GA | Yes |

## Other

- **Enumeration date:** 04/04/2016
- **Last updated:** 04/04/2016