Provider Demographics
NPI:1275267718
Name:LITTLE, JENNA RACKLEY (LCMHCA, RDN)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:RACKLEY
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LCMHCA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 TWIN STAR LN
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6636
Mailing Address - Country:US
Mailing Address - Phone:252-717-8794
Mailing Address - Fax:
Practice Address - Street 1:6604 SIX FORKS RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6521
Practice Address - Country:US
Practice Address - Phone:252-717-8794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health