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General NPI Number Information
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NPI Number | 1710886858
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Entity Type | Organization
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Legal Business Name | RISEN STARS BEHAVIORAL HEALTHCARE, PLLC
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 12584 DARBY BROOK CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2485
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Country | US
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Telephone | 571-394-8687
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Fax |
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Provider Business Mailing Address
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Address Line | 12584 DARBY BROOK CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2485
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Country | US
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Telephone | 571-394-8687
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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 | MR. ANDREW WILMOT
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Credential | PMHNP
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Telephone | 571-394-8687
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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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