Healthcare Provider Details

I. General information

NPI: 1275838898
Provider Name (Legal Business Name): MICHAEL H. BORASH, LPC, P.C. & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13885 HEDGEWOOD DR STE 349
WOODBRIDGE VA
22193-7928
US

IV. Provider business mailing address

13885 HEDGEWOOD DR STE 349
WOODBRIDGE VA
22193-7928
US

V. Phone/Fax

Practice location:
  • Phone: 800-799-1212
  • Fax: 703-580-7840
Mailing address:
  • Phone: 800-799-1212
  • Fax: 703-580-7840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0701000622
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701000622
License Number StateVA

VIII. Authorized Official

Name: MR. MICHAEL HOWARD BORASH
Title or Position: DIRECTOR
Credential: MS, LPC
Phone: 703-492-8939