Basic Information
| Provider Information | |||||||||
| NPI: | 1134229693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORDEN | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW/CAC-1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12717 RIVERVIEW STREET | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135331494 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8623 NORTH WAYNE ROAD, STE. 310 | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344250636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | L790106 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.