Provider Demographics
NPI:1033618715
Name:GUMUL, SAMANTHA N (LMSW-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:N
Last Name:GUMUL
Suffix:
Gender:F
Credentials:LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8261 STARINA CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6811
Mailing Address - Country:US
Mailing Address - Phone:734-612-6295
Mailing Address - Fax:
Practice Address - Street 1:31600 TELEGRAPH RD STE 280
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4317
Practice Address - Country:US
Practice Address - Phone:248-792-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102224104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker