Healthcare Provider Details

I. General information

NPI: 1275496424
Provider Name (Legal Business Name): DISTINCT CARE MENTAL HEALTH AND WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR # 6593
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR # 6593
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 540-255-9729
  • Fax:
Mailing address:
  • Phone: 301-531-4767
  • Fax: 434-404-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LILIAN AZENABOR
Title or Position: NURSE PRACTITIONER
Credential: APRN, PMHNP
Phone: 540-255-9729