Provider Demographics
NPI:1356065486
Name:4 ROSES PSYCHOLOGICAL SERVICES. PLLC
Entity type:Organization
Organization Name:4 ROSES PSYCHOLOGICAL SERVICES. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-705-7922
Mailing Address - Street 1:2961A HUNTER MILL RD # 642
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1704
Mailing Address - Country:US
Mailing Address - Phone:703-705-2922
Mailing Address - Fax:703-705-9336
Practice Address - Street 1:10300 BUSHMAN DR APT 309
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2826
Practice Address - Country:US
Practice Address - Phone:312-543-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health