MEDICARE: COURAGE TO CHANGE MENTAL HEALTH AND WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1861356073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURAGE TO CHANGE MENTAL HEALTH AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	201 E ACADEMY ST STE 304
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E ACADEMY ST STE 304
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2248
Country	:	US
Telephone Number	:	302-858-6415
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	CHRISTINE A WILZACK
Credential	:	PMHNP
Telephone Number	:	302-858-6415

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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