Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Diane Wagner

Individual provider Clinical Psychologist · NPI 1194211540

Diane Wagner is a Clinical Psychologist in Fairfax, Virginia. Qualified in 2017, 9 years ago. Accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
9
Licensed in
VA
In the registry since
2018
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Practice location Address checks out

11325 Random Hills Rd Ste 360
Fairfax, VA 22030-0972
Phone: (703) 646-1518
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 0810006006 (VA)

Record details

NPI number1194211540
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 9, 2018
Last updated in NPPESAugust 27, 2021
Certification dateAugust 27, 2021
Mailing address10911 Adare Dr, Fairfax, VA 22032-3105

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Fairfax