Healthcare Provider Details

I. General information

NPI: 1386132595
Provider Name (Legal Business Name): MS. TONYA ALISHA LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 CHAPEL HILL RD STE A
DURHAM NC
27707-1177
US

IV. Provider business mailing address

2011 BEDFORD ST APT 8
DURHAM NC
27707-2008
US

V. Phone/Fax

Practice location:
  • Phone: 919-246-5664
  • Fax: 919-321-0351
Mailing address:
  • Phone: 919-521-1740
  • Fax: 919-321-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: