Wagner Psychotherapy LLC

NPI #1962179804 in Fairfax, Virginia

Provider Information

NPI Number: 1962179804
Entity Type: Organization
Organization Name: Wagner Psychotherapy LLC
Primary Specialty: Psychologist - Clinical
Enumeration Date: Aug 27, 2021
Last Updated: Aug 27, 2021

Practice Location

Address: 8280 WILLOW OAKS CORPORATE DRIVE
Address 2: SUITE 600 - #5752
City: Fairfax
State: Virginia
ZIP Code: 22031-4516
Phone: (703) 646-1518

Authorized Official

Name: DR. DIANE WAGNER, PHD
Title: OWNER
Phone: (703) 646-1518

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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