Healthcare Provider Details

I. General information

NPI: 1518897610
Provider Name (Legal Business Name): MALACHI NORONHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 DELHI COMMERCE DR STE 4
HOLT MI
48842-2193
US

IV. Provider business mailing address

2044 FOX HILL DR
GRAND BLANC MI
48439-5219
US

V. Phone/Fax

Practice location:
  • Phone: 810-584-5872
  • Fax:
Mailing address:
  • Phone: 810-584-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: