Healthcare Provider Details

I. General information

NPI: 1578283768
Provider Name (Legal Business Name): JESSICA MACUMBER LMSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23332 ORCHARD LAKE RD STE C
FARMINGTON HILLS MI
48336-3280
US

IV. Provider business mailing address

42627 GARFIELD RD STE 214
CLINTON TOWNSHIP MI
48038-5032
US

V. Phone/Fax

Practice location:
  • Phone: 586-310-8158
  • Fax:
Mailing address:
  • Phone: 586-310-8158
  • Fax: 586-261-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121163
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: