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General NPI Number Information
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NPI Number | 1609996081
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Entity Type | Individual
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Provider Name | GLENDA LEIGH LITTLE LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 175 EMERY HWY
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City | MACON
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State | GA
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Zip | 31217-3692
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Country | US
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Telephone | 478-752-1804
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Fax |
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Provider Business Mailing Address
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Address Line | 36 CAMELLIA CIR
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City | JEFFERSONVILLE
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State | GA
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Zip | 31044-3719
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Country | US
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Telephone | 478-945-6681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001049
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License Number State | GA
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