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General NPI Number Information
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NPI Number | 1093369506
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Entity Type | Individual
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Provider Name | ASHLEY GRACE BORCK MA
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 737 WALKER RD STE 1D
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City | GREAT FALLS
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State | VA
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Zip | 22066-3833
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Country | US
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Telephone | 571-305-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 737 WALKER RD STE 1D
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City | GREAT FALLS
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State | VA
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Zip | 22066-3833
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Country | US
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Telephone | 571-305-5733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0704012997
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License Number State | VA
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