Provider Demographics
NPI:1952709255
Name:SANTIAGO, GINGER M (LMHC)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:M
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24059 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-7722
Mailing Address - Country:US
Mailing Address - Phone:352-397-6889
Mailing Address - Fax:866-438-1375
Practice Address - Street 1:24059 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-7722
Practice Address - Country:US
Practice Address - Phone:352-397-6889
Practice Address - Fax:866-438-1375
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021304600Medicaid