Provider Demographics
NPI:1982370136
Name:HASKINS, NATHANIEL DANTE (DSP)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:DANTE
Last Name:HASKINS
Suffix:
Gender:M
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-2834
Mailing Address - Country:US
Mailing Address - Phone:440-645-0366
Mailing Address - Fax:
Practice Address - Street 1:1111 SEYMOUR DR
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5511
Practice Address - Country:US
Practice Address - Phone:440-645-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000111101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral