Provider Demographics
NPI:1245549070
Name:HALBERT, JASON GRANT (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:GRANT
Last Name:HALBERT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STONEYKIRK DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9046
Mailing Address - Country:US
Mailing Address - Phone:251-753-4707
Mailing Address - Fax:
Practice Address - Street 1:32 STONEYKIRK DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9046
Practice Address - Country:US
Practice Address - Phone:251-753-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical