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General NPI Number Information
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NPI Number | 1275496424
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Entity Type | Organization
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Legal Business Name | DISTINCT CARE MENTAL HEALTH AND WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 207 WINNBROOK ST
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City | STAUNTON
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State | VA
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Zip | 24401-9204
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Country | US
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Telephone | 540-255-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 207 WINNBROOK ST
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City | STAUNTON
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State | VA
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Zip | 24401-9204
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Country | US
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Telephone | 540-255-9729
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. LILIAN AZENABOR
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Credential | APRN, PMHNP
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Telephone | 540-255-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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