Provider Demographics
NPI:1003319807
Name:CLARK-BORENSTEIN, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CLARK-BORENSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 MEETING ST STE 230
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-6582
Mailing Address - Country:US
Mailing Address - Phone:704-237-0705
Mailing Address - Fax:980-236-1356
Practice Address - Street 1:3800 MEETING ST STE 230
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-6582
Practice Address - Country:US
Practice Address - Phone:704-237-0705
Practice Address - Fax:980-236-1356
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13607101YM0800X
NC13607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health