Healthcare Provider Details

I. General information

NPI: 1073447496
Provider Name (Legal Business Name): KRISTIN GINGELL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 WATERFORD LAKE DR STE 104
MIDLOTHIAN VA
23112-3994
US

IV. Provider business mailing address

2820 WATERFORD LAKE DR STE 104
MIDLOTHIAN VA
23112-3994
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-7117
  • Fax: 804-505-0905
Mailing address:
  • Phone: 804-562-7117
  • Fax: 804-505-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: