Nicholas Antonio Williams, NCC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701005312 Issued in VA

Practice address

12890 Harbor Dr
Woodbridge, VA 22192-2921

Phone

(571) 316-1020

NPI assigned

Sep 18, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Indelible Changes LLC

  • Mental Health Counselor
  • Woodbridge, VA
  • NPI 1720540107
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1720338627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4191 WATERWAY DR",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220251602",
            "telephone_number": "703-474-0585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12890 HARBOR DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922921",
            "telephone_number": "571-316-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "NICHOLAS",
        "middle_name": "ANTONIO",
        "name_prefix": "Mr.",
        "credential": "NCC, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-18",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "VA",
            "license": "0701005312",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701005312",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701005312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2013135052",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicholas.williams@indeliblechanges.org",
            "affiliation": "N",
            "address_1": "12890 Harbor Dr",
            "city": "Woodbridge",
            "state": "VA",
            "country_code": "US",
            "postal_code": "221922921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Corey E. Williams
• Deborah Morse Williams, APRN
• Gabrielle S Williams, PHARMD
• India Caesar Williams
• Marva C. Williams, M.DIV, MA, LPC
• Raenell Williams, M.D.
• Sheila Williams, LPC
• Juanita Williamson
• Amy Lea Willis, OTR
• Amanda Wilson

• Professional Counselor in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.