Provider Demographics
NPI:1578923850
Name:PAQUIN, TAI MARIE (LADAC)
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:MARIE
Last Name:PAQUIN
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:NEW LAGUNA
Mailing Address - State:NM
Mailing Address - Zip Code:87038-0123
Mailing Address - Country:US
Mailing Address - Phone:505-463-6152
Mailing Address - Fax:
Practice Address - Street 1:85 WEST HWY 22
Practice Address - Street 2:
Practice Address - City:SANTO DOMINGO
Practice Address - State:NM
Practice Address - Zip Code:87052
Practice Address - Country:US
Practice Address - Phone:505-465-3060
Practice Address - Fax:505-465-1178
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0153781101YA0400X
NM0188521101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)