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General NPI Number Information
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NPI Number | 1346704152
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Entity Type | Individual
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Provider Name | MILDRED ITASKA BOROWSKI LPC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 3790 NORTH HIGHWAY 41 SUITE A
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone | 229-262-1000
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Fax | 229-262-1085
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Provider Business Mailing Address
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Address Line | 113 MAPLE ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-4120
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Country | US
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Telephone | 229-740-2771
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC007236
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License Number State | GA
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