Healthcare Provider Details

I. General information

NPI: 1346758109
Provider Name (Legal Business Name): MS. DARIA DITZLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 GREENSBORO STATION PL
MC LEAN VA
22102-3467
US

IV. Provider business mailing address

1765 GREENSBORO STATION PL
MC LEAN VA
22102-3467
US

V. Phone/Fax

Practice location:
  • Phone: 301-246-2351
  • Fax: 317-936-1241
Mailing address:
  • Phone: 301-246-2351
  • Fax: 317-936-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003694
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: