Provider Demographics
NPI:1831252741
Name:LITTLE, SAMUEL RAYFORD (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RAYFORD
Last Name:LITTLE
Suffix:
Gender:M
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BELMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305
Mailing Address - Country:US
Mailing Address - Phone:334-671-1280
Mailing Address - Fax:334-671-0475
Practice Address - Street 1:187 BELMONT DRIVE
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305
Practice Address - Country:US
Practice Address - Phone:334-671-1280
Practice Address - Fax:334-671-0475
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health