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General NPI Number Information
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NPI Number | 1679162929
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Entity Type | Individual
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Provider Name | ANTON WILLIAM DEROSA LPC
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Gender | Male
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 200 LITTLE FALLS ST STE 306
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4302
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Country | US
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Telephone | 202-455-0677
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Fax |
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Provider Business Mailing Address
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Address Line | 6054 FORREST HOLLOW LN
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1428
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Country | US
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Telephone | 914-882-3658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701013232
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License Number State | VA
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