Healthcare Provider Details

I. General information

NPI: 1750926465
Provider Name (Legal Business Name): GWEN BORCYK, MSW, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 WALNUT ST STE 106
WILMINGTON NC
28401-4063
US

IV. Provider business mailing address

313 WALNUT ST STE 106
WILMINGTON NC
28401-4063
US

V. Phone/Fax

Practice location:
  • Phone: 336-345-5565
  • Fax: 910-636-5111
Mailing address:
  • Phone: 336-345-5565
  • Fax: 910-636-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GWEN BORCYK
Title or Position: OWNER/ THERAPIST
Credential: LCSW
Phone: 336-345-5565