Healthcare Provider Details

I. General information

NPI: 1033618715
Provider Name (Legal Business Name): SAMANTHA N GUMUL LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31600 TELEGRAPH RD STE 280
BINGHAM FARMS MI
48025-4317
US

IV. Provider business mailing address

8261 STARINA CT
BRIGHTON MI
48116-6811
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-8093
  • Fax:
Mailing address:
  • Phone: 734-612-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801102224
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801102224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: