Provider Demographics
NPI:1336624543
Name:MILITARY SUPPLEMENTAL COUNSELING CENTER, LLP
Entity Type:Organization
Organization Name:MILITARY SUPPLEMENTAL COUNSELING CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:C
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:
Practice Address - Street 1:825 GUM BRANCH RD STE 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6293
Practice Address - Country:US
Practice Address - Phone:336-345-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty