Provider Demographics
NPI:1033364583
Name:BORDEN, SANDRA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:BORDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6330 NEWTOWN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4805
Mailing Address - Country:US
Mailing Address - Phone:757-466-1325
Mailing Address - Fax:757-455-5750
Practice Address - Street 1:6330 NEWTOWN RD STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4805
Practice Address - Country:US
Practice Address - Phone:757-466-1325
Practice Address - Fax:757-455-5750
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical