Healthcare Provider Details

I. General information

NPI: 1689482630
Provider Name (Legal Business Name): CHRISTOPHER DAVID HAAKE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 LINDEN DR STE 111
WINCHESTER VA
22601-2892
US

IV. Provider business mailing address

326 ROCK SPRING DR SW
LEESBURG VA
20175-2618
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-4881
  • Fax: 540-536-3274
Mailing address:
  • Phone: 413-695-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001304657
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN1043524
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024192569
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: