Provider Demographics
NPI:1508894601
Name:GINGRAS, TERRY JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JAMES
Last Name:GINGRAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 DENBIGH BLVD
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4427
Mailing Address - Country:US
Mailing Address - Phone:757-833-7107
Mailing Address - Fax:757-833-7109
Practice Address - Street 1:710 DENBIGH BLVD
Practice Address - Street 2:SUITE 6B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4427
Practice Address - Country:US
Practice Address - Phone:757-833-7107
Practice Address - Fax:757-833-7109
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001800103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA331480OtherBLUE CROSS/BLUE SHIELD
VA338160OtherOPTIMUM/MAMSI
VA0321329OtherVALUE OPTIONS
VA5265267OtherAETNA
VI085455OtherSENTARA/OPTIMA