Provider Demographics
NPI:1184358731
Name:LITTLEBRANT, AUTUMN JEAN (LCSW-A)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:JEAN
Last Name:LITTLEBRANT
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:JEAN
Other - Last Name:ATWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-0281
Mailing Address - Country:US
Mailing Address - Phone:910-253-5885
Mailing Address - Fax:
Practice Address - Street 1:610 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4048
Practice Address - Country:US
Practice Address - Phone:910-253-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0176871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical