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General NPI Number Information
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NPI Number | 1770622144
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Entity Type | Individual
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Provider Name | MARYBETH LITTLE LISW-S
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 323 MARION PIKE STE 1
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City | COAL GROVE
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State | OH
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Zip | 45638-2958
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Country | US
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Telephone | 740-237-4981
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Fax |
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Provider Business Mailing Address
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Address Line | 323 MARION PIKE STE 1
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City | COAL GROVE
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State | OH
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Zip | 45638-2958
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Country | US
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Telephone | 740-237-4981
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | KY-3038
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.1450659-SUPV
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | I.1450659-SUPV
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License Number State | OH
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