Healthcare Provider Details

I. General information

NPI: 1952010100
Provider Name (Legal Business Name): DESIREE WEATHERSBY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE WEATHERSBY MSW, LCSW

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BORO PL FL 4
MC LEAN VA
22102-3627
US

IV. Provider business mailing address

8591 RICHMOND AVE
MANASSAS VA
20110-5867
US

V. Phone/Fax

Practice location:
  • Phone: 571-202-7420
  • Fax:
Mailing address:
  • Phone: 202-664-2083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014531
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: