Healthcare Provider Details

I. General information

NPI: 1770295123
Provider Name (Legal Business Name): SARA E ROSENQUIST P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MICHAEL FARADAY DR STE 206
RESTON VA
20190-5312
US

IV. Provider business mailing address

5909 EDGEHILL DR
ALEXANDRIA VA
22303-1310
US

V. Phone/Fax

Practice location:
  • Phone: 866-337-4911
  • Fax: 866-919-4850
Mailing address:
  • Phone: 866-337-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SARA ELLEN ROSENQUIST
Title or Position: EXECUTIVE OFFICER
Credential: PHD
Phone: 866-337-4911