Provider Demographics
NPI:1073866554
Name:LITTLE, LETISHIA (LPC)
Entity Type:Individual
Prefix:
First Name:LETISHIA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2324
Mailing Address - Country:US
Mailing Address - Phone:973-485-0265
Mailing Address - Fax:973-481-5241
Practice Address - Street 1:744 RIDGE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2324
Practice Address - Country:US
Practice Address - Phone:973-485-0265
Practice Address - Fax:973-481-5241
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00444900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional