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General NPI Number Information
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NPI Number | 1144598202
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Entity Type | Individual
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Provider Name | LORI MARIE BORG M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 705 S MAIN ST SUITE 280
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City | PLYMOUTH
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State | MI
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Zip | 48170-2089
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Country | US
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Telephone | 734-454-3560
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Fax |
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Provider Business Mailing Address
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Address Line | 23405 W. LE BOST
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City | NOVI
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State | MI
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Zip | 48375
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Country | US
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Telephone | 313-283-3112
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | L1846640
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License Number State | MI
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