Healthcare Provider Details

I. General information

NPI: 1629331889
Provider Name (Legal Business Name): COURTNEY M LITTLE AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY CAMPBELL

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S CARLIN SPRINGS RD STE 106
ARLINGTON VA
22204-1061
US

IV. Provider business mailing address

611 S CARLIN SPRINGS RD STE 106
ARLINGTON VA
22204-1061
US

V. Phone/Fax

Practice location:
  • Phone: 703-933-2001
  • Fax:
Mailing address:
  • Phone: 703-933-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001623
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: