Provider Demographics
NPI:1114034618
Name:WILLCOX, DANA (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:
Last Name:WILLCOX
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20884-0644
Mailing Address - Country:US
Mailing Address - Phone:301-216-0930
Mailing Address - Fax:301-216-0930
Practice Address - Street 1:13-15 E DEER PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2070
Practice Address - Country:US
Practice Address - Phone:301-216-0930
Practice Address - Fax:310-216-0930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD026621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02662OtherSOCIAL WORK LICENSE #