Provider Demographics
NPI:1144400292
Name:RICHARDSON, TIA AVETTE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TIA
Middle Name:AVETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29877 TELEGRAPH RD STE 401
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7661
Mailing Address - Country:US
Mailing Address - Phone:248-358-5334
Mailing Address - Fax:248-356-7596
Practice Address - Street 1:29877 TELEGRAPH RD STE 401
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7661
Practice Address - Country:US
Practice Address - Phone:248-358-5334
Practice Address - Fax:248-356-7596
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health