MEDICARE: TINA EALEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401224849	MI
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1649831280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA EALEY LLC

Provider Business Mailing Address
First Line	:	20216 ALBANY ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-2505
Country	:	US
Telephone Number	:	734-366-9424
Fax Number	:

Provider Business Practice Location Address
First Line	:	20216 ALBANY ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-2505
Country	:	US
Telephone Number	:	734-366-9424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	04/06/2025

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Directions to “ TINA EALEY LLC” Practice Location

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