Provider Demographics
NPI:1912410218
Name:BORLAND, LOIS NANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:NANNETTE
Last Name:BORLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:NANNETTE
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 KILCULLEN DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7301
Mailing Address - Country:US
Mailing Address - Phone:850-582-6562
Mailing Address - Fax:
Practice Address - Street 1:4400 E HIGHWAY 20 STE 306
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-7703
Practice Address - Country:US
Practice Address - Phone:850-897-7810
Practice Address - Fax:850-897-0032
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW101161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical