Healthcare Provider Details

I. General information

NPI: 1508620485
Provider Name (Legal Business Name): ZACKARY HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 11/25/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W BROAD ST FL 2
COLUMBUS OH
43222-1464
US

IV. Provider business mailing address

4000 E MAIN ST
COLUMBUS OH
43213-3593
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-0822
  • Fax:
Mailing address:
  • Phone: 614-334-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.188461
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: