Healthcare Provider Details

I. General information

NPI: 1992092654
Provider Name (Legal Business Name): LITTLE LEAVES EARLY LEARNING THERAPY AND PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 COLUMBIA GATEWAY DR STE A
COLUMBIA MD
21046-2322
US

IV. Provider business mailing address

7150 COLUMBIA GATEWAY DR STE A
COLUMBIA MD
21046-2322
US

V. Phone/Fax

Practice location:
  • Phone: 202-420-8359
  • Fax: 202-318-2351
Mailing address:
  • Phone: 202-420-8359
  • Fax: 202-318-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-03-1325
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4416
License Number StateMD

VIII. Authorized Official

Name: JENNIFER LEWIS
Title or Position: DIRECTOR OF CENTER DEVELOPMENT
Credential:
Phone: 202-992-7257