| Doctor Name: | TIA ROSE POTTS |
| NPI Number: | 1457361735 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS OF PSYCHOLOGY |
| License Number: | |
| Business Practice Address: | 1400 E 12 Mile Rd Madison Hts, MI - 480712651 |
| Business Phone Number: | 2485472223 |
| Business Fax Number: | 2485472226 |
| Mailing Address: | 20075 Northville Place Dr Apt 3106, NORTHVILLE |
| State: | MI |
| Postal Code: | 481672961 |
| Phone Number: | 2487739900 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2006 |
| NPI Last Update Date: | 04/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |