NPIMap

Organization Active NPI

Groundwork Healing LLC

  • Mental Health Counselor
  • Bangor, ME
National Provider Identifier
1033964432
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
GROUNDWORK HEALING LLC
Practice address
12 Stillwater Ave Ste 7
Bangor, ME 04401-3984
Phone
(918) 344-7844
NPI assigned
Apr 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Brooklin Jones-Banahan, LCSW, LCSW
Title
Clinical Director
Phone
(207) 941-0879

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

12 Stillwater Ave Ste 7
Bangor, ME 04401-3984

Mailing address

12 Stillwater Ave Ste 7
Bangor, ME 04401-3984

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250310000070 ME Part B Supplier - Clinic/Group Practice 4082135819 Receives reassigned benefits from 6 practitioners
Practice locations: Bangor, ME

National Provider Directory

National Provider Directory

Locations

12 Stillwater Ave
Ste 7
Bangor, ME 04401
Phone (207) 941-0879

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1033964432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 STILLWATER AVE STE 7",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 STILLWATER AVE STE 7",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013984",
            "telephone_number": "918-344-7844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROUNDWORK HEALING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-19",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "JONES-BANAHAN, LCSW",
        "authorized_official_first_name": "BROOKLIN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "207-941-0879",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.