Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E ACADEMY ST STE 304
FUQUAY VARINA NC
27526-2248
US

IV. Provider business mailing address

201 E ACADEMY ST STE 304
FUQUAY VARINA NC
27526-2248
US

V. Phone/Fax

Practice location:
  • Phone: 302-858-6415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE A WILZACK
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP
Phone: 302-858-6415