Provider Demographics
NPI:1750926465
Name:GWEN BORCYK, MSW, LCSW, PLLC
Entity type:Organization
Organization Name:GWEN BORCYK, MSW, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCYK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-345-5565
Mailing Address - Street 1:313 WALNUT ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4063
Mailing Address - Country:US
Mailing Address - Phone:336-345-5565
Mailing Address - Fax:910-636-5111
Practice Address - Street 1:313 WALNUT ST STE 106
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4063
Practice Address - Country:US
Practice Address - Phone:336-345-5565
Practice Address - Fax:910-636-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)