Provider Demographics
NPI:1346997087
Name:VALDES BORSUM, LAURA A (MS, MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:VALDES BORSUM
Suffix:
Gender:F
Credentials:MS, MA, LCPC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:VALDES-BORSUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MA, LCPC
Mailing Address - Street 1:2609 ISLAND GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3313
Mailing Address - Country:US
Mailing Address - Phone:240-422-3966
Mailing Address - Fax:
Practice Address - Street 1:2609 ISLAND GROVE BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3313
Practice Address - Country:US
Practice Address - Phone:240-422-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional