Organization
WAGNER PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE WAGNER PHD (OWNER)
(703) 646-1518
Entity
Organization
Contact information
Practice address
8280 WILLOW OAKS CORPORATE DRIVE, SUITE 600 - #5752, FAIRFAX, VA 22031-4516
(703) 646-1518
Mailing address
10911 ADARE DR, FAIRFAX, VA 22032-3105
(703) 646-1518
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
08/27/2021
Last updated
08/27/2021
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