Provider Demographics
NPI:1801667217
Name:MADDEN, WILLIAM TYRONE
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TYRONE
Last Name:MADDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 TRIBUTARY CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7030
Mailing Address - Country:US
Mailing Address - Phone:336-303-5522
Mailing Address - Fax:
Practice Address - Street 1:344 TRIBUTARY CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7030
Practice Address - Country:US
Practice Address - Phone:336-303-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities