NPIMap

Organization Active NPI

Derosa Wellness Innovation, LLC

  • Professional Counselor
  • Reston, VA
National Provider Identifier
1124716519
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
DEROSA WELLNESS INNOVATION, LLC
Practice address
11921 Freedom Dr Ste 550
Reston, VA 20190-5635
Phone
(703) 826-1353
NPI assigned
Apr 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Shirley Derosa, LPCNPI 1730889635
Title
Director
Phone
(703) 826-1353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

11921 Freedom Dr Ste 550
Reston, VA 20190-5635

Mailing address

11921 Freedom Dr Ste 550
Reston, VA 20190-5635
Phone (703) 826-1353

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1124716519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11921 FREEDOM DR STE 550",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905635",
            "telephone_number": "703-826-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11921 FREEDOM DR STE 550",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905635",
            "telephone_number": "703-826-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEROSA WELLNESS INNOVATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-25",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "DEROSA",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-826-1353",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.