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INDELIBLE CHANGES LLC
NPI 1720540107
Counselor - Mental Health in Woodbridge, VA

Active since April 03, 2019
12890 HARBOR DR, WOODBRIDGE, VA 22192(570) 316-1020 Get Directions Write a Review

NPPES record last updated: December 14, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 14, 2022, Apr 17, 2019, Apr 3, 2019 (3 updates tracked since 2019).

About Indelible Changes Llc NPPES

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

INDELIBLE CHANGES LLC (NPI 1720540107) is a healthcare organization registered as a mental health in Woodbridge, Virginia and active in the NPI registry since April 2019. The organization lists Nicholas Antonio Williams, Ceo, as its authorized official.

NPPES Registry Identity

NPI1720540107
Entity TypeOrganization
Primary Taxonomy101YM0800X
Legal Business NameINDELIBLE CHANGES LLC
Location Address12890 HARBOR DRWoodbridge, VA 22192-2921
Mailing Address4191 Waterway DrDumfries, VA 22025-1602 · (703) 474-0585
Phone(570) 316-1020
Organization SubpartNo
Authorized OfficialNicholas Antonio WilliamsCeo · (703) 474-0585
Enumeration DateApril 3, 2019
Last NPPES UpdateDecember 14, 20223 updates tracked since enumeration
NPPES CertifiedDecember 14, 2022
✔ NPI 1720540107 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 9

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
Also ListedCounselorTaxonomy 101Y00000X
Also ListedPsychologistTaxonomy 103T00000X
Also ListedSocial WorkerTaxonomy 104100000X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
Also ListedMarriage & Family TherapistTaxonomy 106H00000X
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X
Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X
12890 HARBOR DR, Woodbridge, VA 22192
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Other Identifiers 1

Medicaid575326118VA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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
MR. NICHOLAS ANTONIO WILLIAMS NCC, LPC
Counselor (Professional)
12890 HARBOR DR
WOODBRIDGE, VA 22192
Prince William County (571) 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 Indelible Changes LLC's NPI number?

The NPI number for Indelible Changes LLC is 1720540107. It was assigned to this organization in the NPPES registry on April 3, 2019.

Where is Indelible Changes LLC located?

Indelible Changes LLC is located at 12890 Harbor Dr, Woodbridge, VA 22192. The listed phone number is (570) 316-1020.

What is Indelible Changes LLC's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Indelible Changes LLC 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.