Healthcare Provider Details

I. General information

NPI: 1083532436
Provider Name (Legal Business Name): LITTLE LIGHT BEHAVIORAL HEALTH STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29777 TELEGRAPH RD STE 4200
SOUTHFIELD MI
48034-7640
US

IV. Provider business mailing address

29777 TELEGRAPH RD STE 4200
SOUTHFIELD MI
48034-7640
US

V. Phone/Fax

Practice location:
  • Phone: 248-979-9077
  • Fax:
Mailing address:
  • Phone: 248-979-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIARA MACHELLE PORTER
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 248-979-9077