Provider Demographics
NPI:1346484649
Name:SHAHEEN, CRISTINE (PCC)
Entity Type:Individual
Prefix:MS
First Name:CRISTINE
Middle Name:
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STARRIT ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3916
Mailing Address - Country:US
Mailing Address - Phone:614-307-4555
Mailing Address - Fax:
Practice Address - Street 1:112 STARRIT ST
Practice Address - Street 2:SUITE 211
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3916
Practice Address - Country:US
Practice Address - Phone:614-307-4555
Practice Address - Fax:740-687-4641
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500524101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional