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MR. NICHOLAS ANTONIO WILLIAMS NCC, LPC
NPI 1720338627
Counselor - Professional in Woodbridge, VA

Active since September 18, 2012PECOS EnrolledAccepts Medicare Assignment
12890 HARBOR DR, WOODBRIDGE, VA 22192(571) 316-1020 Get Directions Write a Review

NPPES record last updated: December 14, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 14, 2022, Apr 3, 2019 (2 updates tracked since 2019).

About Mr. Nicholas Antonio Williams Ncc, Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. NICHOLAS ANTONIO WILLIAMS NCC, LPC (NPI 1720338627) is an individual professional provider in Woodbridge, Virginia, licensed in Virginia (0701005312) and active in the NPI registry since September 2012. He is enrolled in Medicare PECOS and is a graduate of Other (2008).

NPPES Registry Identity

NPI1720338627
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameMR. NICHOLAS ANTONIO WILLIAMSCredential: NCC, LPC
Location Address12890 HARBOR DRWoodbridge, VA 22192-2921
Mailing Address4191 Waterway DrDumfries, VA 22025-1602 · (703) 474-0585
Phone(571) 316-1020
Sole ProprietorYes
Medical School CMSOtherGraduated 2008
Enumeration DateSeptember 18, 2012
Last NPPES UpdateDecember 14, 20222 updates tracked since enumeration
NPPES CertifiedDecember 14, 2022
✔ NPI 1720338627 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in VA · 0701005312
Also ListedCounselorTaxonomy 101Y00000X · License 0701005312 (VA)
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 0701005312 (VA)
12890 HARBOR DR, Woodbridge, VA 22192
Open in Google Maps ↗

Other Identifiers 1

Medicaid2013135052VA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Nicholas Antonio Williams Ncc, Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7517297161
PECOS Enrollment IDI20240415004076
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Nicholas Williams reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Indelible Changes LLC
Same address
Mental Health
12890 HARBOR DR
Woodbridge, VA 22192
  • Reassigned Medicare billing, Virginia enrollment
  • 4 clinicians in this Medicare group
NPI 1720540107 (570) 316-1020

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LINDA P. JOHNSON
Case Management
12890 HARBOR DR
WOODBRIDGE, VA 22192
Prince William County (706) 541-1606
SHUAIYING LIU
Counselor (Mental Health)
12890 HARBOR DR
WOODBRIDGE, VA 22192
Prince William County (855) 643-5787
SHEILA WILLIAMS LPC
Counselor (Mental Health)
12890 HARBOR DR
WOODBRIDGE, VA 22192
Prince William County (571) 316-1020
DR. LAWRENCE E. SUTTON L.P.C.
Counselor (Mental Health)
12890 HARBOR DR
WOODBRIDGE, VA 22192
Prince William County (703) 490-3497
INDELIBLE CHANGES LLC
Counselor (Mental Health)
12890 HARBOR DR
WOODBRIDGE, VA 22192
Prince William County (570) 316-1020
MRS. LINDA P JOHNSON LCSW
Social Worker (Clinical)
12890 HARBOR DR
WOODBRIDGE, VA 22192
Prince William County (703) 541-1606

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicholas Williams's NPI number?

The NPI number for Nicholas Williams is 1720338627. It was assigned to this individual provider in the NPPES registry on September 18, 2012.

Where is Nicholas Williams located?

Nicholas Williams practices at 12890 Harbor Dr, Woodbridge, VA 22192. The listed phone number is (571) 316-1020.

What is Nicholas Williams's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Nicholas Williams enrolled in Medicare?

Yes. Nicholas Williams is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Nicholas Williams's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Williams reassigns Medicare benefits to Indelible Changes LLC (Woodbridge, VA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicholas Williams's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Nicholas Williams accept?

Health plans from Oscar Health list Nicholas Williams as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nicholas Williams was last updated on December 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.