Provider Demographics
NPI:1922417708
Name:NORRIS, MICHELLE CELESTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CELESTE
Last Name:NORRIS
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 1:695 ATHERTON PL
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-6600
Mailing Address - Country:US
Mailing Address - Phone:510-305-9144
Mailing Address - Fax:
Practice Address - Street 1:695 ATHERTON PL
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-6600
Practice Address - Country:US
Practice Address - Phone:510-305-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI4630812101YA0400X, 101YA0400X
CAASW 624901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical