Healthcare Provider Details

I. General information

NPI: 1205762499
Provider Name (Legal Business Name): CHRISTINE MARIE DESIDERATI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6629 SACAGAWEA ST
RUTHER GLEN VA
22546-2966
US

IV. Provider business mailing address

6629 SACAGAWEA ST
RUTHER GLEN VA
22546-2966
US

V. Phone/Fax

Practice location:
  • Phone: 540-379-8859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016235
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: