Provider Demographics
NPI:1649597550
Name:LITTLE, FENESSA (BSW)
Entity Type:Individual
Prefix:
First Name:FENESSA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 KINKEAD RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7704
Mailing Address - Country:US
Mailing Address - Phone:918-429-8184
Mailing Address - Fax:918-426-5439
Practice Address - Street 1:1019 KINKEAD RD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7704
Practice Address - Country:US
Practice Address - Phone:918-429-8184
Practice Address - Fax:918-426-5439
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker