Provider Demographics
NPI:1619346392
Name:BORYS, MARK REINER (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:REINER
Last Name:BORYS
Suffix:
Gender:M
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CHAMPLAIN ST NW
Mailing Address - Street 2:APT 112
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-8700
Mailing Address - Country:US
Mailing Address - Phone:202-888-5595
Mailing Address - Fax:
Practice Address - Street 1:1330 U ST NW, THIRD FLOOR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-888-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14697101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional