Healthcare Provider Details

I. General information

NPI: 1144130345
Provider Name (Legal Business Name): HUBERT FOMUNYAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EASTERN AVE NE
WASHINGTON DC
20019-2833
US

IV. Provider business mailing address

10419 STONE PINE AVE
WALDORF MD
20603-5797
US

V. Phone/Fax

Practice location:
  • Phone: 202-248-1356
  • Fax: 202-978-5970
Mailing address:
  • Phone: 301-818-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: