Provider Demographics
NPI:1225495120
Name:GINGRAS, REBEKAH (PSYD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:GINGRAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WOMACK ARMY MEDICAL CENTER, DOBH
Mailing Address - Street 2:2817 ROCK MERRITT AVE
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-6825
Mailing Address - Fax:
Practice Address - Street 1:WOMACK ARMY MEDICAL CENTER, DOBH
Practice Address - Street 2:2817 ROCK MERRITT AVE
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4871103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program