Provider Demographics
NPI:1588953905
Name:BORSARE, TERRENCE EDWARD (LPC)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:EDWARD
Last Name:BORSARE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CREEKSTONE BND
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2246
Mailing Address - Country:US
Mailing Address - Phone:404-664-5606
Mailing Address - Fax:
Practice Address - Street 1:2000 W MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-6265
Practice Address - Country:US
Practice Address - Phone:770-228-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional