Healthcare Provider Details

I. General information

NPI: 1881560522
Provider Name (Legal Business Name): CRISTHIAN HAQUIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9039 ANTARES AVE STE B
COLUMBUS OH
43240-4067
US

IV. Provider business mailing address

9039 ANTARES AVE STE B
COLUMBUS OH
43240-4067
US

V. Phone/Fax

Practice location:
  • Phone: 614-505-0077
  • Fax: 614-505-0077
Mailing address:
  • Phone: 614-505-0091
  • Fax: 614-505-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: