Provider Demographics
NPI:1548892755
Name:HOLLENBECK, DONALD GENE JR
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:GENE
Last Name:HOLLENBECK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12532 MISTY WATER DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5702
Mailing Address - Country:US
Mailing Address - Phone:571-232-0271
Mailing Address - Fax:
Practice Address - Street 1:10513 BRADDOCK RD
Practice Address - Street 2:SUITE C/D (UPSTAIRS)
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2276
Practice Address - Country:US
Practice Address - Phone:703-995-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
251C00000XOtherCOGNITIVE TRAINING
VA251C00000XOtherDAY TRAINING, DEVELOPMENTALLY DISABLED SERVICES