Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 081160 | OH |
N | 101YM0800X | Mental Health Counselor | ||
N | 101YM0800X | Mental Health Counselor | OH | |
N | 101YM0800X | Mental Health Counselor | S1100316 | OH |
N | 101YP1600X | Pastoral Counselor | OH | |
N | 101YP1600X | Pastoral Counselor | 000000 | OH |
N | 104100000X | Social Worker | S1100316 | OH |
NPI | 1154819431 |
---|---|
Provider Name | Mr. Michael Andrew Little |
First Address | Fairfield Township, OH 45011-7895 |
Second Address | Dayton, OH 45417-3445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 23/04/2018 |