Individual
TIA ROSE POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS OF PSYCHOLOGY
Contact information
Practice address
1400 E 12 MILE RD, MADISON HTS, MI 48071-2651
(248) 547-2223
(248) 547-2226
Mailing address
20075 NORTHVILLE PLACE DR APT 3106, NORTHVILLE, MI 48167-2961
(248) 773-9900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
631090
—
MI
Enumeration date
08/09/2006
Last updated
04/08/2008
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