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

Q: 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.

Q: What is Indelible Changes LLC's specialty?

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

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: October 18, 2026.

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

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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Indelible Changes Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Indelible Changes LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Nicholas Williams, NCC, LPC

Mental Health Counselor

NPI 1720338627

12890 HARBOR DR
Woodbridge, VA 22192

(571) 316-1020

✔ PECOS✔ Accepts MedicareSame address

Sheila Williams, LPC

Mental Health Counselor

NPI 1558252726

12890 HARBOR DR
Woodbridge, VA 22192

(571) 316-1020

✔ PECOSSame address

Joanne Perdu Ouimet, LPC

Mental Health Counselor

NPI 1023622230

INDELIBLE CHANGES 4191 WATERWAY DR.
Montclair, VA 22026

(855) 643-5787

✔ PECOS7.9 mi

Joshua Sloan, LPC

Mental Health Counselor

NPI 1790574317

9202 CENTER OAK CT
Mechanicsville, VA 23116

(804) 207-6737

✔ PECOS✔ Accepts Medicare71 mi

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

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.

Is Indelible Changes LLC enrolled in Medicare?

Yes. Indelible Changes LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Indelible Changes LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Mental Health Counselor, reassign their Medicare billing to Indelible Changes LLC. A 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 the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.