Healthcare Provider Details

I. General information

NPI: 1851839252
Provider Name (Legal Business Name): CAROLYN LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2103
US

IV. Provider business mailing address

199 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2103
US

V. Phone/Fax

Practice location:
  • Phone: 513-616-8774
  • Fax: 513-861-0105
Mailing address:
  • Phone: 513-616-8774
  • Fax: 513-861-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: