Provider Demographics
NPI:1396003331
Name:IAIN HALSTEAD LLC
Entity Type:Organization
Organization Name:IAIN HALSTEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HALSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-792-8677
Mailing Address - Street 1:3855 SHALLOWFORD RD STE 420
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4197
Mailing Address - Country:US
Mailing Address - Phone:678-792-8677
Mailing Address - Fax:770-993-8004
Practice Address - Street 1:3855 SHALLOWFORD RD STE 420
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4197
Practice Address - Country:US
Practice Address - Phone:678-792-8677
Practice Address - Fax:770-993-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0035981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty