Provider Demographics
NPI:1619552700
Name:BORJA, FAYEANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FAYEANNE
Middle Name:
Last Name:BORJA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19841
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:404-393-4510
Practice Address - Street 1:830 GLENWOOD AVE.
Practice Address - Street 2:STE 510-332
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3032
Practice Address - Country:US
Practice Address - Phone:404-484-9249
Practice Address - Fax:404-393-4510
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional