Provider Demographics
NPI:1427328384
Name:BORNIA, INGRID MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:MARIE
Last Name:BORNIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COLISEUM CROSSING
Mailing Address - Street 2:#138
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5962
Mailing Address - Country:US
Mailing Address - Phone:757-893-0321
Mailing Address - Fax:
Practice Address - Street 1:110 COLISEUM CROSSING
Practice Address - Street 2:# 138
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5971
Practice Address - Country:US
Practice Address - Phone:757-893-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040077721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical