Provider Demographics
NPI:1134229693
Name:BORDEN, SALLY N (LMSW/CAC-1)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:N
Last Name:BORDEN
Suffix:
Gender:F
Credentials:LMSW/CAC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 RIVERVIEW STREET
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223
Mailing Address - Country:US
Mailing Address - Phone:313-533-1494
Mailing Address - Fax:
Practice Address - Street 1:8623 NORTH WAYNE ROAD, STE. 310
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185
Practice Address - Country:US
Practice Address - Phone:734-425-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL790106101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)