Provider Demographics
NPI:1275789380
Name:LITTLE, MARY ANNETTE (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNETTE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-6323
Mailing Address - Country:US
Mailing Address - Phone:615-504-2777
Mailing Address - Fax:615-460-5556
Practice Address - Street 1:2006 ADAMS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:TN
Practice Address - Zip Code:37036-6323
Practice Address - Country:US
Practice Address - Phone:615-504-2777
Practice Address - Fax:615-460-5556
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1062814222Q00000X
TN1-06-2814103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist