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General NPI Number Information
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NPI Number | 1356065486
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Entity Type | Organization
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Legal Business Name | 4 ROSES PSYCHOLOGICAL SERVICES. PLLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 10300 BUSHMAN DR APT 309
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City | OAKTON
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State | VA
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Zip | 22124-2826
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Country | US
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Telephone | 312-543-5107
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Fax |
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Provider Business Mailing Address
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Address Line | 2961A HUNTER MILL RD # 642
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City | OAKTON
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State | VA
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Zip | 22124-1704
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Country | US
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Telephone | 703-705-2922
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Fax | 703-705-9336
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. DEBRA FERGUSON
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Credential | PH.D.
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Telephone | 703-705-7922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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