Provider Demographics
NPI:1841950656
Name:LITTLE, MICHELLE ANNETTE (BS, RBT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OZARK TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8847
Mailing Address - Country:US
Mailing Address - Phone:678-431-0849
Mailing Address - Fax:
Practice Address - Street 1:3229 S CHEROKEE LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4461
Practice Address - Country:US
Practice Address - Phone:470-499-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician