Provider Demographics
NPI:1538506001
Name:BORCYK, GWEN COLLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:COLLEEN
Last Name:BORCYK
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 1:3418 OSPREY LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2534
Mailing Address - Country:US
Mailing Address - Phone:336-345-5565
Mailing Address - Fax:
Practice Address - Street 1:3418 OSPREY LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2534
Practice Address - Country:US
Practice Address - Phone:336-345-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0092521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical