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General NPI Number Information
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NPI Number | 1619691201
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Entity Type | Individual
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Provider Name | CHANITA RENEE LITTLE
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Gender | Female
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 8 EXECUTIVE DR STE 200
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City | FAIRVIEW HTS
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State | IL
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Zip | 62208-1350
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Country | US
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Telephone | 618-688-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 2745 CEDAR GROVE DR
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City | BELLEVILLE
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State | IL
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Zip | 62221-7411
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Country | US
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Telephone | 618-604-0488
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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