Basic Information
| Provider Information | |||||||||
| NPI: | 1861701955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLOUD | ||||||||
| FirstName: | GINGER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MS, LADC, LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 320 | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056670320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024548336 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 157 TOWNE AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056679425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024548336 | ||||||||
| FaxNumber: | 8024548339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2010 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP1600X | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.