Indelible Changes LLC
NPI 1720540107 · Mental Health Counselor · Woodbridge, VA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Indelible Changes LLC is a Mental Health Counselor organization in Woodbridge, VA (NPI 1720540107).
Provider details
- NPI number
- 1720540107
- Entity type
- Organization
- Primary specialty
- Mental Health CounselorBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Nicholas Williams, Ceo(703) 474-0585
Specialties & taxonomies
Behavioral Health & Social Service Providers
- Counselor101Y00000X
Behavioral Health & Social Service Providers
- Psychologist103T00000X
Behavioral Health & Social Service Providers
- Social Worker104100000X
Behavioral Health & Social Service Providers
- Clinical Social Worker1041C0700X
Behavioral Health & Social Service Providers
- Marriage & Family Therapist106H00000X
Behavioral Health & Social Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2019-04-03
- Last updated
- 2022-12-14
- Certified
- 2022-12-14
Frequently asked questions
- What is Indelible Changes LLC's NPI number?
- Indelible Changes LLC's National Provider Identifier (NPI) is 1720540107, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Indelible Changes LLC?
- Indelible Changes LLC is classified in the NPPES registry as Mental Health Counselor (Behavioral Health & Social Service Providers).
- Where is Indelible Changes LLC located?
- Indelible Changes LLC's practice location on file with NPPES is 12890 Harbor Dr, Woodbridge, VA 22192-2921.
- What is Indelible Changes LLC's phone number?
- The practice phone number listed in the NPPES registry for Indelible Changes LLC is (570) 316-1020.
- Does Indelible Changes LLC accept Medicare?
- Indelible Changes LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Indelible Changes LLC?
- The authorized official listed on Indelible Changes LLC's NPPES record is Nicholas Williams, Ceo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Indelible Changes LLC's NPI active?
- Yes — Indelible Changes LLC's NPI (1720540107) is active in the NPPES registry as of the last update on 2022-12-14.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.