Provider Demographics
NPI:1336671940
Name:LITTLE, KANDACE ELLEN-MARIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KANDACE
Middle Name:ELLEN-MARIE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1120
Mailing Address - Country:US
Mailing Address - Phone:254-338-1158
Mailing Address - Fax:
Practice Address - Street 1:421 COOPER AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1120
Practice Address - Country:US
Practice Address - Phone:254-338-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-25681103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst