Healthcare Provider Details

I. General information

NPI: 1225235070
Provider Name (Legal Business Name): DEBORAH LEAH ROTTER LCSW, CHT, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 WILDFLOWER DR
FAIRFAX STATION VA
22039-2436
US

IV. Provider business mailing address

8100 WILDFLOWER DR
FAIRFAX STATION VA
22039-2436
US

V. Phone/Fax

Practice location:
  • Phone: 703-239-0697
  • Fax:
Mailing address:
  • Phone: 703-239-0697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: