MEDICARE: MS. LISA S. LITTLEJOHN MBA, MA, NCC, LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	A8923	NC
2	101YM0800X	Mental Health Counselor	A8923	NC
3	101YP2500X	Professional Counselor	A8923	NC

General Provider Information

NPI Number	:	1598109936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA S. LITTLEJOHN MBA, MA, NCC, LPCA

Provider Business Mailing Address
First Line	:	4712 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-2508
Country	:	US
Telephone Number	:	704-281-8416
Fax Number	:

Provider Business Practice Location Address
First Line	:	4712 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-2508
Country	:	US
Telephone Number	:	704-281-8416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2013
Last Update Date	:	05/08/2013

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