Healthcare Provider Details

I. General information

NPI: 1700982386
Provider Name (Legal Business Name): NANCY A LITTLE PCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 HESS ST
GRANDVIEW OH
43212-2679
US

IV. Provider business mailing address

1508 HESS ST
GRANDVIEW OH
43212-2679
US

V. Phone/Fax

Practice location:
  • Phone: 614-999-4122
  • Fax: 888-216-8339
Mailing address:
  • Phone: 614-999-4122
  • Fax: 888-216-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE7723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: