Provider Demographics
NPI:1013176528
Name:BORASH, MICHAEL HOWARD (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:BORASH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 OLD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2708
Mailing Address - Country:US
Mailing Address - Phone:800-799-1212
Mailing Address - Fax:703-492-7768
Practice Address - Street 1:1388 OLD BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2708
Practice Address - Country:US
Practice Address - Phone:800-799-1212
Practice Address - Fax:703-492-7768
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health