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WAGNER PSYCHOTHERAPY LLC
NPI 1962179804
Psychologist - Clinical in Fairfax, VA

Active since August 27, 2021
8280 WILLOW OAKS CORPORATE DRIVE, SUITE 600 - #5752, FAIRFAX, VA 22031(703) 646-1518 Get Directions Write a Review

NPPES record last updated: August 27, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Wagner Psychotherapy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WAGNER PSYCHOTHERAPY LLC (NPI 1962179804) is a healthcare organization registered as a clinical in Fairfax, Virginia and active in the NPI registry since August 2021. The organization lists Diane Wagner, Owner, as its authorized official.

NPPES Registry Identity

NPI1962179804
Entity TypeOrganization
Primary Taxonomy103TC0700X
Legal Business NameWAGNER PSYCHOTHERAPY LLC
Location Address8280 WILLOW OAKS CORPORATE DRIVE, SUITE 600 - #5752Fairfax, VA 22031-4516
Mailing Address10911 Adare DrFairfax, VA 22032-3105 · (703) 646-1518
Phone(703) 646-1518
Organization SubpartNo
Authorized OfficialDiane WagnerOwner · (703) 646-1518
Enumeration DateAugust 27, 2021
NPPES CertifiedAugust 27, 2021
✔ NPI 1962179804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
8280 WILLOW OAKS CORPORATE DRIVE, Fairfax, VA 22031
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wagner Psychotherapy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Wagner Psychotherapy LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Diane Wagner
Clinical Psychologist
NPI 1194211540
11325 RANDOM HILLS RD STE 360
Fairfax, VA 22030
(703) 646-1518
✔ PECOS✔ Accepts Medicare5.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wagner Psychotherapy LLC's NPI number?

The NPI number for Wagner Psychotherapy LLC is 1962179804. It was assigned to this organization in the NPPES registry on August 27, 2021.

Where is Wagner Psychotherapy LLC located?

Wagner Psychotherapy LLC is located at 8280 Willow Oaks Corporate Drive Suite 600 - #5752, Fairfax, VA 22031. The listed phone number is (703) 646-1518.

What is Wagner Psychotherapy LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Wagner Psychotherapy LLC enrolled in Medicare?

Yes. Wagner Psychotherapy LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Wagner Psychotherapy LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Wagner Psychotherapy LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Wagner Psychotherapy LLC was last updated on August 27, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.