Provider Demographics
NPI:1093369506
Name:BORCK, ASHLEY GRACE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:GRACE
Last Name:BORCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 WALKER RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-3833
Mailing Address - Country:US
Mailing Address - Phone:571-305-5733
Mailing Address - Fax:
Practice Address - Street 1:737 WALKER RD STE 1D
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-3833
Practice Address - Country:US
Practice Address - Phone:571-305-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704012997101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor