Provider Demographics
NPI:1972757516
Name:LITTLETON, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LITTLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:BONIFACIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 2533
Mailing Address - Street 2:
Mailing Address - City:WRIGHTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:92397-2533
Mailing Address - Country:US
Mailing Address - Phone:805-694-8538
Mailing Address - Fax:
Practice Address - Street 1:26650 TIMBERLINE DRIVE
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:CA
Practice Address - Zip Code:93544
Practice Address - Country:US
Practice Address - Phone:805-694-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA92722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator