Provider Demographics
NPI:1275810285
Name:LITTLE, PAMELA TELINA (MA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:TELINA
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 SPRING FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4878
Mailing Address - Country:US
Mailing Address - Phone:240-501-1336
Mailing Address - Fax:
Practice Address - Street 1:9701 APOLLO DR
Practice Address - Street 2:SUITE 301
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4783
Practice Address - Country:US
Practice Address - Phone:240-501-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional