Provider Demographics
NPI:1861090896
Name:WILSON-BUTTS, NIYHOSI (SOBER LIVING PROGRAM)
Entity type:Individual
Prefix:MS
First Name:NIYHOSI
Middle Name:
Last Name:WILSON-BUTTS
Suffix:
Gender:F
Credentials:SOBER LIVING PROGRAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-3206
Mailing Address - Country:US
Mailing Address - Phone:302-377-4910
Mailing Address - Fax:
Practice Address - Street 1:222 E 30TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3206
Practice Address - Country:US
Practice Address - Phone:302-377-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility