Healthcare Provider Details

I. General information

NPI: 1073433033
Provider Name (Legal Business Name): WILLIAM FONCHAM III LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD STE U3
BERWYN HEIGHTS MD
20740-2361
US

IV. Provider business mailing address

3645 ELDER OAKS BLVD APT 7106
BOWIE MD
20716-3398
US

V. Phone/Fax

Practice location:
  • Phone: 301-747-7038
  • Fax:
Mailing address:
  • Phone:
  • 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: