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General NPI Number Information
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NPI Number | 1588953905
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Entity Type | Individual
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Provider Name | TERRENCE EDWARD BORSARE LPC
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Gender | Male
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 2000 W MCINTOSH RD
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City | GRIFFIN
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State | GA
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Zip | 30223-6265
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Country | US
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Telephone | 770-228-2307
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Fax |
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Provider Business Mailing Address
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Address Line | 202 CREEKSTONE BND
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2246
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Country | US
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Telephone | 404-664-5606
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC006199
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License Number State | GA
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