Provider Demographics
NPI:1659534493
Name:GONCZ, DOUGLAS DANA (CPS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DANA
Last Name:GONCZ
Suffix:
Gender:
Credentials:CPS
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 4394
Mailing Address - Street 2:
Mailing Address - City:SEVEN CORNERS
Mailing Address - State:VA
Mailing Address - Zip Code:22044-0394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3041 PATRICK HENRY DR 2
Practice Address - Street 2:THE 4 BUTTON IS STICKY
Practice Address - City:SEVEN CORNERS
Practice Address - State:VA
Practice Address - Zip Code:22044-2536
Practice Address - Country:US
Practice Address - Phone:703-534-0870
Practice Address - Fax:571-395-3575
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier