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General NPI Number Information
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NPI Number | 1871788331
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Entity Type | Organization
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Legal Business Name | ELIZABETH W. BORG PHD DSC PC
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 580 FOREST AVE STE 1B
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City | PLYMOUTH
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State | MI
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Zip | 48170-1780
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Country | US
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Telephone | 734-453-2207
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Fax |
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Provider Business Mailing Address
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Address Line | 6426 KINGS MILL CT
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City | CANTON
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State | MI
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Zip | 48187-5480
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Country | US
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Telephone | 734-453-2207
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Fax | 734-453-8415
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ELIZABETH W BORG
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Credential | PH.D.
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Telephone | 734-453-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6301008127
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License Number State | MI
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