Individual
GIDEON FONKWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2000 TOWER OAKS BLVD, ROCKVILLE, MD 20852-4282
(301) 444-5001
Mailing address
2000 TOWER OAKS BLVD, ROCKVILLE, MD 20852-4282
(301) 444-5001
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/08/2023
Last updated
07/03/2024
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