Healthcare Provider Details

I. General information

NPI: 1053223578
Provider Name (Legal Business Name): TY NORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 KINGSTON CT SE STE F
MARIETTA GA
30067-8952
US

IV. Provider business mailing address

2130 KINGSTON CT SE STE F
MARIETTA GA
30067-8952
US

V. Phone/Fax

Practice location:
  • Phone: 678-304-8215
  • Fax:
Mailing address:
  • Phone: 678-304-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: