Provider Demographics
NPI:1386814705
Name:KELLEY, MALAIKA
Entity Type:Individual
Prefix:MISS
First Name:MALAIKA
Middle Name:
Last Name:KELLEY
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 1:736 WESTERN ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3409
Mailing Address - Country:US
Mailing Address - Phone:313-957-8132
Mailing Address - Fax:
Practice Address - Street 1:7845 MIDDLEBELT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-2174
Practice Address - Country:US
Practice Address - Phone:734-721-0900
Practice Address - Fax:734-721-0909
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803081921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)