Provider Demographics
NPI:1063134443
Name:LOWELL, GINGER KAYE (CDCA)
Entity type:Individual
Prefix:MS
First Name:GINGER
Middle Name:KAYE
Last Name:LOWELL
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1003
Mailing Address - Country:US
Mailing Address - Phone:937-661-1221
Mailing Address - Fax:
Practice Address - Street 1:48 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2731
Practice Address - Country:US
Practice Address - Phone:937-481-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187781101YA0400X
101YM0800X
OHQBHS171M00000X
OHCDCA.187781101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator