Individual
LAKEISHA JOY-LITTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15744 BAINEBRIDGE DR, JACKSONVILLE, FL 32218-8349
(904) 469-5933
Mailing address
15744 BAINEBRIDGE DR, JACKSONVILLE, FL 32218-8349
(904) 469-5933
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
689847596
—
FL
Enumeration date
05/24/2008
Last updated
08/28/2020
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