Provider Demographics
NPI:1639226012
Name:GINGRAS, JOHN LAWRENCE (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LAWRENCE
Last Name:GINGRAS
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20925 PROFESSIONAL PLAZA, SUITE 230
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-858-7838
Mailing Address - Fax:703-858-9697
Practice Address - Street 1:20925 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE 230
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:703-858-7838
Practice Address - Fax:703-858-9697
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional