Provider Demographics
NPI:1104395847
Name:LITTLE, PAMELA YVONNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:YVONNE
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-0157
Mailing Address - Country:US
Mailing Address - Phone:770-861-0251
Mailing Address - Fax:
Practice Address - Street 1:2107 CHARLES CUDD CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3601
Practice Address - Country:US
Practice Address - Phone:770-861-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional