Healthcare Provider Details

I. General information

NPI: 1871788331
Provider Name (Legal Business Name): ELIZABETH W. BORG PHD DSC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 FOREST AVE STE 1B
PLYMOUTH MI
48170-1780
US

IV. Provider business mailing address

6426 KINGS MILL CT
CANTON MI
48187-5480
US

V. Phone/Fax

Practice location:
  • Phone: 734-453-2207
  • Fax:
Mailing address:
  • Phone: 734-453-2207
  • Fax: 734-453-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6301008127
License Number StateMI

VIII. Authorized Official

Name: DR. ELIZABETH W BORG
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 734-453-2207