Provider Demographics
NPI:1821529660
Name:HALSTEAD, JESSICA (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3204
Mailing Address - Country:US
Mailing Address - Phone:304-552-5597
Mailing Address - Fax:
Practice Address - Street 1:4855 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1331
Practice Address - Country:US
Practice Address - Phone:304-720-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00942576104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker