Organization
IMPACT COUNSELING, COACHING & CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYRUS WILLIAMS III PHD, LPC, (OWNER/CLINICAL SUPERVISOR)
(757) 354-3025
Entity
Organization
Contact information
Practice address
1000 REGENT UNIVERSITY DR, VIRGINIA BEACH, VA 23464-5037
(757) 354-3025
Mailing address
1000 REGENT UNIVERSITY DR, VIRGINIA BEACH, VA 23464-5037
(757) 354-3025
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083841779
CIGNA MEDICAL
VA
05
—
1083841779
—
VA
Enumeration date
10/17/2022
Last updated
11/14/2022
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