Active NPI
Dewight Edwin Wilson, RADT1
- Addiction (Substance Use Disorder) Counselor
- Vallejo, CA
National Provider Identifier
1699221945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 11966
- Practice address
- 419 Pennsylvania St
Vallejo, CA 94590-6933 - Phone
- (707) 643-2715
- Fax
- (707) 643-8536
- NPI assigned
- Aug 28, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11966 | CA | Primary |
Addresses
Primary practice location
419 Pennsylvania St
Vallejo, CA 94590-6933
Mailing address
419 Pennsylvania St.
Vallejo, CA 94590
Phone (707) 643-2715
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472342400000",
"number": "1699221945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 PENNSYLVANIA ST.",
"city": "VALLEJO",
"state": "CA",
"postal_code": "94590",
"telephone_number": "707-643-2715",
"fax_number": "707-643-8536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 PENNSYLVANIA ST",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945906933",
"telephone_number": "707-643-2715",
"fax_number": "707-643-8536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DEWIGHT",
"middle_name": "EDWIN",
"name_prefix": "Mr.",
"credential": "RADT1",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-28",
"last_updated": "2016-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "11966",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.