Provider Demographics
NPI:1326487034
Name:LITTLE, MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:PLEMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW, LCSW
Mailing Address - Street 1:53 POMONA CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8190
Mailing Address - Country:US
Mailing Address - Phone:423-802-8115
Mailing Address - Fax:
Practice Address - Street 1:53 POMONA CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-8190
Practice Address - Country:US
Practice Address - Phone:423-802-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099260561041C0700X
GACSW0071301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1659004299OtherNPI II
GA1659004299OtherNPI II