Provider Demographics
NPI:1699791236
Name:LITTLE, MAROLYN ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:MAROLYN
Middle Name:ANN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-0222
Mailing Address - Country:US
Mailing Address - Phone:864-617-1385
Mailing Address - Fax:
Practice Address - Street 1:225 ADLEY WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6511
Practice Address - Country:US
Practice Address - Phone:864-987-9747
Practice Address - Fax:864-987-9770
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1180363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health