Provider Demographics
NPI:1710423116
Name:BORREL, LAUREL
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:BORREL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 N PARHAM RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4411
Mailing Address - Country:US
Mailing Address - Phone:804-658-5930
Mailing Address - Fax:804-658-5404
Practice Address - Street 1:2817 N PARHAM RD
Practice Address - Street 2:SUITE 211
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4411
Practice Address - Country:US
Practice Address - Phone:804-658-5930
Practice Address - Fax:804-658-5404
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2574-03-001251S00000X
VA4652416922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health