Carol Williams Nickelson, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810007253 Issued in VA

Practice address

20925 Professional PLZ Ste 230
Ashburn, VA 20147-3403

Phone

(703) 621-7121

NPI assigned

Apr 2, 2020

Last updated

Oct 4, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Carol Williams Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: granatogroup.carolwilliamsnickelson@144557.advancedmd-direct.com

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

• Drscd and Associates

  dba Clarity Psychological Services, LLC

  • Clinical Psychologist
  • Leesburg, VA
  • NPI 1942945076
  NPD Authorized official

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601769600000",
    "number": "1922637982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21385 GLEBE VIEW DR",
            "city": "BROADLANDS",
            "state": "VA",
            "postal_code": "201483629",
            "telephone_number": "703-723-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20925 PROFESSIONAL PLZ STE 230",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201473403",
            "telephone_number": "703-621-7121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21385 Glebe View Dr",
            "address_purpose": "LOCATION",
            "city": "Broadlands",
            "state": "VA",
            "postal_code": "201483629",
            "country_code": "US",
            "telephone_number": "703-723-0119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "CAROL",
        "middle_name": "WILLIAMS",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-02",
        "last_updated": "2020-10-04",
        "certification_date": "2020-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810007253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "WILLIAMS",
            "credential": "MS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Khanh Vy Nguyen, DDS
• Mike H Nguyen, DDS
• Minhhieu Nguyen, PHARMD
• Phuong-Uyen Nhy Nguyen, D.D.S
• Tam Minh Nguyen, PHARM. D
• Nikkhah, PLC
• Pouran Nikkhah, D.M.D.
• Matt Nikpourfard, DDS
• Patrick Joseph Nisco II, PH.D.
• Niyan Home Healthcare, LLC (Assisting Hands of Loudoun)

• Clinical Psychologist in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.