Healthcare Provider Details

I. General information

NPI: 1093291874
Provider Name (Legal Business Name): JMA CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PEARL ST STE 304
YPSILANTI MI
48197-2663
US

IV. Provider business mailing address

124 PEARL ST STE 304
YPSILANTI MI
48197-2663
US

V. Phone/Fax

Practice location:
  • Phone: 734-720-4888
  • Fax: 734-720-4884
Mailing address:
  • Phone: 734-720-4888
  • Fax: 734-720-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098160
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JEWELETTER M ANDERSON
Title or Position: OWNER AND CLINICIAN
Credential: LMSW, CAADC
Phone: 734-720-4888