Healthcare Provider Details

I. General information

NPI: 1629227517
Provider Name (Legal Business Name): DONALD MATHEW TAGGART MS, CAADC, LCDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 E. MAIN ST. OPEN DOOR, INC.
NEWARK DE
19711
US

IV. Provider business mailing address

501 W 14TH ST STE 1E40
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-1504
  • Fax: 302-731-2720
Mailing address:
  • Phone: 302-320-6356
  • Fax: 302-320-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCD-0000025
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: