Healthcare Provider Details

I. General information

NPI: 1225948680
Provider Name (Legal Business Name): WAVES OF CHANGE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LINCOLN HWY STE 210
EDISON NJ
08820-3965
US

IV. Provider business mailing address

7 LINCOLN HWY STE 210
EDISON NJ
08820-3965
US

V. Phone/Fax

Practice location:
  • Phone: 908-219-9133
  • Fax:
Mailing address:
  • Phone: 908-219-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER NICHOLAS
Title or Position: FOUNDER AND PSYCHOTHERAPIST
Credential: LPC
Phone: 908-219-9133