Healthcare Provider Details

I. General information

NPI: 1508894601
Provider Name (Legal Business Name): TERRY JAMES GINGRAS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 DENBIGH BLVD SUITE 6B
NEWPORT NEWS VA
23608-4427
US

IV. Provider business mailing address

710 DENBIGH BLVD SUITE 6B
NEWPORT NEWS VA
23608-4427
US

V. Phone/Fax

Practice location:
  • Phone: 757-833-7107
  • Fax: 757-833-7109
Mailing address:
  • Phone: 757-833-7107
  • Fax: 757-833-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810001800
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001800
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: