Healthcare Provider Details

I. General information

NPI: 1336058379
Provider Name (Legal Business Name): RILEY LITTLEJOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 SENNA DR STE B
MATTHEWS NC
28105-6727
US

IV. Provider business mailing address

754 KITFOX DR NW
CONCORD NC
28027-8999
US

V. Phone/Fax

Practice location:
  • Phone: 980-533-5649
  • Fax:
Mailing address:
  • Phone: 704-771-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23474
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: