Healthcare Provider Details

I. General information

NPI: 1053229088
Provider Name (Legal Business Name): JACKSON BORCHERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 FAIRMOUNT AVE STE 200
TOWSON MD
21286-8503
US

IV. Provider business mailing address

2 DOWLING CIR APT T2
PARKVILLE MD
21234-6628
US

V. Phone/Fax

Practice location:
  • Phone: 410-216-1594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18413
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: