Provider Demographics
NPI:1952830176
Name:BORGLUM, SUSAN GERDA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GERDA
Last Name:BORGLUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOULTON ST E
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2310
Mailing Address - Country:US
Mailing Address - Phone:256-822-2375
Mailing Address - Fax:
Practice Address - Street 1:16 MOULTON ST E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-2310
Practice Address - Country:US
Practice Address - Phone:256-822-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health