Provider Demographics
NPI:1811025083
Name:BORCHARDT, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BORCHARDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 D ST
Mailing Address - Street 2:ROOM 301
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0455
Mailing Address - Country:US
Mailing Address - Phone:707-476-1298
Mailing Address - Fax:
Practice Address - Street 1:134 D ST
Practice Address - Street 2:ROOM 301
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0455
Practice Address - Country:US
Practice Address - Phone:707-476-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker