Provider Demographics
NPI:1942717434
Name:HALLSWORTH, KRISTEN (MED)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HALLSWORTH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:1155 HEMBREE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4635
Mailing Address - Country:US
Mailing Address - Phone:770-250-0093
Mailing Address - Fax:678-412-1662
Practice Address - Street 1:1155 HEMBREE RD STE 210
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4635
Practice Address - Country:US
Practice Address - Phone:770-250-0093
Practice Address - Fax:678-412-1662
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst