Provider Demographics
NPI:1932426517
Name:POTTS, KATHERINE JEANE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JEANE
Last Name:POTTS
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 1:1130 PARKER ST APT 116
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2680
Mailing Address - Country:US
Mailing Address - Phone:734-855-9275
Mailing Address - Fax:
Practice Address - Street 1:4081 CHESTER DR.
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1521
Practice Address - Country:US
Practice Address - Phone:734-855-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010864211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical