Provider Demographics
NPI:1992440911
Name:NORRELL-AITCH, KEA
Entity type:Individual
Prefix:
First Name:KEA
Middle Name:
Last Name:NORRELL-AITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36205 WEBER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4647
Mailing Address - Country:US
Mailing Address - Phone:313-995-1126
Mailing Address - Fax:
Practice Address - Street 1:29425 NORTHWESTERN HWY STE 215
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1000
Practice Address - Country:US
Practice Address - Phone:248-327-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health