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General NPI Number Information
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NPI Number | 1881301893
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Entity Type | Individual
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Provider Name | JUMOI-ANTONIO SHEMAR-DAVID REID LLPC, LLMFT, MA, NCC
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Gender | Male
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 31815 SOUTHFIELD RD STE 18
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-480-0115
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Fax | 248-282-7114
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Provider Business Mailing Address
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Address Line | 31815 SOUTHFIELD RD STE 18
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-480-0115
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Fax | 248-282-7114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451022605
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4151001077
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451022605
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License Number State | MI
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