Provider Demographics
NPI:1609452325
Name:LITTLE CHICK LLC
Entity Type:Organization
Organization Name:LITTLE CHICK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:JAE
Authorized Official - Last Name:WILBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-314-1802
Mailing Address - Street 1:3001 PEMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-2254
Mailing Address - Country:US
Mailing Address - Phone:407-314-1802
Mailing Address - Fax:
Practice Address - Street 1:3001 PEMBROOK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2254
Practice Address - Country:US
Practice Address - Phone:407-314-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty