Provider Demographics
NPI:1568751121
Name:LITTLE, DEREZMA LASHON (QP, MA)
Entity Type:Individual
Prefix:MS
First Name:DEREZMA
Middle Name:LASHON
Last Name:LITTLE
Suffix:
Gender:F
Credentials:QP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BATTLEGROUND AVE. APT. 30
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:336-931-1800
Mailing Address - Fax:336-931-1801
Practice Address - Street 1:7900 TRIAD CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9073
Practice Address - Country:US
Practice Address - Phone:336-931-1800
Practice Address - Fax:336-931-1802
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101YM0800XMedicaid