Provider Demographics
NPI:1184053738
Name:BOREK, DAVID (LPC, LCADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BOREK
Suffix:
Gender:M
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EVESBORO MEDFORD RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3865
Mailing Address - Country:US
Mailing Address - Phone:609-353-5608
Mailing Address - Fax:609-798-0092
Practice Address - Street 1:105 EVESBORO MEDFORD RD
Practice Address - Street 2:SUITE M
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3865
Practice Address - Country:US
Practice Address - Phone:609-353-5608
Practice Address - Fax:609-798-0092
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00521100101YP2500X
NJ37LC00228000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)