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General NPI Number Information
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NPI Number | 1962706176
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Entity Type | Individual
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Provider Name | CYNTHIA WAGNER LPC
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Gender | Female
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/27/2019
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Provider Practice Location Address
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Address Line | 3801 FAIRFAX DR STE 61
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City | ARLINGTON
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State | VA
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Zip | 22203-1762
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Country | US
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Telephone | 571-523-7760
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 S CLEVELAND ST APT 361
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City | ARLINGTON
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State | VA
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Zip | 22204-4848
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Country | US
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Telephone | 703-597-6928
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC14138
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005467
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License Number State | VA
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