Provider Demographics
NPI:1760177224
Name:MFONYAM, BINWI (QMHP-ADULT)
Entity Type:Individual
Prefix:DR
First Name:BINWI
Middle Name:
Last Name:MFONYAM
Suffix:
Gender:F
Credentials:QMHP-ADULT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 LARCHDALE RD APT 8
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1756
Mailing Address - Country:US
Mailing Address - Phone:434-378-9696
Mailing Address - Fax:
Practice Address - Street 1:13121 LARCHDALE RD APT 8
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1756
Practice Address - Country:US
Practice Address - Phone:434-378-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health