Provider Demographics
NPI:1013358803
Name:BORDERS, MARIANNA (PCMHT)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:BORDERS
Suffix:
Gender:F
Credentials:PCMHT
Other - Prefix:
Other - First Name:MARIANNA
Other - Middle Name:
Other - Last Name:BORDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCMHT
Mailing Address - Street 1:1701 WHITE ST
Mailing Address - Street 2:PO BOX 768
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2711
Mailing Address - Country:US
Mailing Address - Phone:601-249-4228
Mailing Address - Fax:601-249-4244
Practice Address - Street 1:1701 WHITE ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2711
Practice Address - Country:US
Practice Address - Phone:601-249-4228
Practice Address - Fax:601-249-4244
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health