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General NPI Number Information
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NPI Number | 1962940486
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Entity Type | Individual
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Provider Name | MONIQUE LITTLE LPCC INTERN
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Gender | Female
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 1172 3RD AVE
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City | CHULA VISTA
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State | CA
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Zip | 91911-3116
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Country | US
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Telephone | 619-691-1662
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Fax |
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Provider Business Mailing Address
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Address Line | 8240 VALLEY VIEW CIR #152
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City | LA MESA
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State | CA
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Zip | 91941-8430
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Country | US
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Telephone | 773-562-7943
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3248
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License Number State | CA
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