Provider Demographics
NPI:1053192690
Name:LITTLE, GREGORY DAEVOND
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAEVOND
Last Name:LITTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N CAPITOL ST NW APT C501
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7537
Mailing Address - Country:US
Mailing Address - Phone:202-907-6195
Mailing Address - Fax:
Practice Address - Street 1:1221 TAYLOR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5617
Practice Address - Country:US
Practice Address - Phone:202-464-9200
Practice Address - Fax:202-291-2160
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician