Healthcare Provider Details

I. General information

NPI: 1689334492
Provider Name (Legal Business Name): TIANNA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35300 NANKIN BLVD
WESTLAND MI
48185-7222
US

IV. Provider business mailing address

25154 LYNDON
REDFORD MI
48239-3314
US

V. Phone/Fax

Practice location:
  • Phone: 888-355-5433
  • Fax:
Mailing address:
  • Phone: 313-445-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: