Wagner Psychotherapy LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

WAGNER PSYCHOTHERAPY LLC

Practice address

8280 Willow Oaks Corporate Drive
Suite 600 - #5752
Fairfax, VA 22031-4516

Phone

(703) 646-1518

NPI assigned

Aug 27, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Diane Wagner, PHDNPI 1194211540

Title

Owner

Phone

(703) 646-1518

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diane Wagner

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1194211540

  DC

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1962179804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10911 ADARE DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220323105",
            "telephone_number": "703-646-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8280 WILLOW OAKS CORPORATE DRIVE",
            "address_2": "SUITE 600 - #5752",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314516",
            "telephone_number": "703-646-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-646-1518",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Oliver Wade, LPC
• Karianne Lynne Wade
• Raymond C Wadlow, MD
• Barbara Jane Wagar, PSY.D.
• Johanne Mae Waggy, NP
• Cecyle Wagner, PT, DPT
• Diane Wagner
• Robert Harrison Wagner, MD
• Samuel Charles Wagner V, LPC
• Leina Wahba, MD

• Clinical Psychologist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.