Provider Demographics
NPI:1033829692
Name:LITTLE, LASHEDA ANTRICE
Entity Type:Individual
Prefix:
First Name:LASHEDA
Middle Name:ANTRICE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 NORTHPOINT BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4999
Mailing Address - Country:US
Mailing Address - Phone:423-707-2863
Mailing Address - Fax:
Practice Address - Street 1:1961 NORTHPOINT BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4999
Practice Address - Country:US
Practice Address - Phone:423-707-2863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician