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

Similar Medicare Providers

1487280848 — A SAFE PLACE COUNSELLING AND COMMUNITY SUPPORT SERVICES L3C
Practice Location Address:

20216 ALBANY ST
DETROIT, MI
48234-2505

Practice Phone: 313-384-4783
Practice Fax:

1336995133 — DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH, INC.
Practice Location Address:

1240 3RD ST
DETROIT, MI
48226-2505

Practice Phone: 313-635-4213
Practice Fax:

1598502817 — DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC.
Practice Location Address:

1240 3RD ST
DETROIT, MI
48226-2505

Practice Phone: 313-831-3160
Practice Fax:

1033925474 — KENESHA JONES
Practice Location Address:

1240 3RD ST
DETROIT, MI
48226-2505

Practice Phone: 313-831-3160
Practice Fax:

1942167820 — MS. NAKIA YVETTE GULLETT RN
Practice Location Address:

1240 3RD ST
DETROIT, MI
48226-2505

Practice Phone: 313-831-3160
Practice Fax:

1538001987 — KAEVON ELEY
Practice Location Address:

18090 BELAND ST
DETROIT, MI
48234-3838

Practice Phone: 248-941-5356
Practice Fax:

Directions to “ TINA EALEY LLC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.