Healthcare Provider Details

I. General information

NPI: 1801580105
Provider Name (Legal Business Name): GINGER ROOT COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 STORER ST STE 403B
KENNEBUNK ME
04043-6885
US

IV. Provider business mailing address

45 PORTLAND RD STE 7 # 245
KENNEBUNK ME
04043
US

V. Phone/Fax

Practice location:
  • Phone: 313-335-4958
  • Fax:
Mailing address:
  • Phone: 313-335-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN E TOMA
Title or Position: OWNER
Credential: MA, LPC, LCPC, ATR
Phone: 313-335-4958