Individual
JAY F DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
179 S PARKSIDE DR, COLORADO SPRINGS, CO 80910-3130
(719) 572-6100
Mailing address
1795 JET WING DR, COLORADO SPRINGS, CO 80916-2332
(719) 572-6100
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC.0019830
CO
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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