| Derosa Wellness Innovation, Llc | |
|
11921 Freedom Dr Ste 550 Reston VA 20190-5635 | |
| (703) 826-1353 | |
| Not Available |
| Full Name | Derosa Wellness Innovation, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 11921 Freedom Dr Ste 550, Reston, Virginia |
| Authorized Official Name and Position | Shirley Derosa (DIRECTOR) |
| Authorized Official Contact | 7038261353 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derosa Wellness Innovation, Llc 11921 Freedom Dr Ste 550 Reston VA 20190-5635 Ph: (703) 826-1353 | Derosa Wellness Innovation, Llc 11921 Freedom Dr Ste 550 Reston VA 20190-5635 Ph: (703) 826-1353 |
| NPI Number | 1124716519 |
|---|---|
| Provider Enumeration Date | 04/25/2023 |
| Last Update Date | 04/26/2023 |
| Certification Date | 04/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124716519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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