Provider Demographics
NPI:1245742212
Name:BORDUIN, RACHEL ELIZABETH (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:BORDUIN
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19945 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1116
Mailing Address - Country:US
Mailing Address - Phone:231-670-4160
Mailing Address - Fax:
Practice Address - Street 1:215 E BIG BEAVER RD STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1216
Practice Address - Country:US
Practice Address - Phone:248-265-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health