Healthcare Provider Details

I. General information

NPI: 1407300072
Provider Name (Legal Business Name): RICHARD MATTHEWS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 COLLEGE RD STE 105
DOVER DE
19904-6506
US

IV. Provider business mailing address

1012 COLLEGE RD STE 105
DOVER DE
19904-6506
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-7015
  • Fax: 302-672-7102
Mailing address:
  • Phone: 302-672-7015
  • Fax: 302-672-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1059
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: