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Organization
INDELIBLE CHANGES LLC
Active
Organization
INDELIBLE CHANGES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS ANTONIO WILLIAMS LPC (CEO)
(703) 474-0585
Entity
Organization
Contact information
Practice address
12890 HARBOR DR, WOODBRIDGE, VA 22192-2921
(570) 316-1020
Mailing address
4191 WATERWAY DR, DUMFRIES, VA 22025-1602
(703) 474-0585
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
575326118
—
VA
Enumeration date
04/03/2019
Last updated
12/14/2022
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