Provider Demographics
NPI:1134350119
Name:LITTLE, MISTY DAWN (LSW)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 SUSQUEHANNA TRL
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-8109
Mailing Address - Country:US
Mailing Address - Phone:570-538-1240
Mailing Address - Fax:
Practice Address - Street 1:759 SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-8109
Practice Address - Country:US
Practice Address - Phone:570-538-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126271101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW126271OtherLICENSE NUMBER