Healthcare Provider Details

I. General information

NPI: 1306349402
Provider Name (Legal Business Name): DIANE MARIE ROSS ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4511
US

IV. Provider business mailing address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4511
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPPS-0648187
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: