Individual
CAROLYN LITTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1325 SYCAMORE RD, DEKALB, IL 60115-2483
(815) 758-8616
Mailing address
PO BOX 1109, DEKALB, IL 60115-7109
(815) 766-3308
(815) 756-2944
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474579189001
—
IL
Enumeration date
07/22/2020
Last updated
04/12/2021
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