Provider Demographics
NPI:1538670005
Name:HALLIWELL, GEORGE W III (LPC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:HALLIWELL
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LORELEI DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2845
Mailing Address - Country:US
Mailing Address - Phone:732-915-9114
Mailing Address - Fax:
Practice Address - Street 1:55 ROUTE 35 STE 6
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5918
Practice Address - Country:US
Practice Address - Phone:732-784-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00478900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional