Healthcare Provider Details

I. General information

NPI: 1619890779
Provider Name (Legal Business Name): DEVANTE LITTLEJOHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 BUNDY ST
SCRANTON PA
18508-1756
US

IV. Provider business mailing address

1854 BUNDY ST
SCRANTON PA
18508-1756
US

V. Phone/Fax

Practice location:
  • Phone: 347-639-2795
  • Fax:
Mailing address:
  • Phone: 347-639-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020790
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: