Provider Demographics
NPI:1346435187
Name:BORDERS, ANGELA JILL (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JILL
Last Name:BORDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2424
Mailing Address - Country:US
Mailing Address - Phone:336-710-6035
Mailing Address - Fax:
Practice Address - Street 1:535 E PINE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3951
Practice Address - Country:US
Practice Address - Phone:336-710-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO18361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical