Active NPI
William Edward Nichelson III, PH.D.
- Clinical Psychologist
- Williamsburg, VA
National Provider Identifier
1184000259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810004646
- Practice address
- 4740 Regents Park
Williamsburg, VA 23188-1798 - Phone
- (865) 696-8369
- NPI assigned
- Jul 30, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810004646 | VA | Primary |
Addresses
Primary practice location
4740 Regents Park
Williamsburg, VA 23188-1798
Mailing address
4740 Regents Park
Williamsburg, VA 23188-1798
Phone (865) 696-8369
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810004646 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438214400000",
"number": "1184000259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4740 REGENTS PARK",
"city": "WILLIAMSBURG",
"state": "VA",
"postal_code": "231881798",
"telephone_number": "865-696-8369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 REGENTS PARK",
"city": "WILLIAMSBURG",
"state": "VA",
"postal_code": "231881798",
"telephone_number": "865-696-8369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHELSON",
"first_name": "WILLIAM",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-30",
"last_updated": "2015-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810004646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamsburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.