Shirley Derosa, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701012114 Issued in VA

Practice address

11921 Freedom Dr Ste 550
Reston, VA 20190-5635

Phone

(703) 826-1353

NPI assigned

Mar 8, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Derosa Wellness Innovation, LLC

  • Professional Counselor
  • Reston, VA
  • NPI 1124716519
  NPD Authorized official

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

{
    "created_epoch": "1678233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1730889635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3043 BRONZEGATE CT",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201711532"
        },
        {
            "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": {
        "last_name": "DEROSA",
        "first_name": "SHIRLEY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-08",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701012114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Dennison, NP
• Dentart Smile Center PLLC
• Dentlux Smile Aesthetics (Reston Town Center Dental)
• Dermatology Specialists of Virginia PC
• Derosa Wellness Innovation, LLC
• Ananya Dhoundiyal
• Sarah Harwood Dial, RN, CNS
• Amy Elizabeth Diehl, BCBA
• Carly Diffenderfer
• Pam L Diffley, CRNA

• Professional Counselor in Reston, VA
• Providers in Reston, VA by specialty
• Professional Counselor in Virginia

• 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.