Healthcare Provider Details

I. General information

NPI: 1538497672
Provider Name (Legal Business Name): MRS. DEBBIE MARIE LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PLYMOUTH RD STE 100
PLYMOUTH MI
48170-1898
US

IV. Provider business mailing address

409 PLYMOUTH RD STE 100
PLYMOUTH MI
48170-1898
US

V. Phone/Fax

Practice location:
  • Phone: 734-927-1201
  • Fax: 734-927-1203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301013658
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: