Healthcare Provider Details

I. General information

NPI: 1083831218
Provider Name (Legal Business Name): FONYA HELM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 RIVERSIDE AVE
CABIN JOHN MD
20818-1627
US

IV. Provider business mailing address

8000 RIVERSIDE AVE
CABIN JOHN MD
20818-1627
US

V. Phone/Fax

Practice location:
  • Phone: 301-229-9120
  • Fax: 310-229-7239
Mailing address:
  • Phone: 301-229-9120
  • Fax: 310-229-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1008
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number755
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002446
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: