Healthcare Provider Details

I. General information

NPI: 1598358384
Provider Name (Legal Business Name): NICK OF TIME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 HULL STREET RD STE 300
NORTH CHESTERFIELD VA
23235-6481
US

IV. Provider business mailing address

PO BOX 37235
NORTH CHESTERFIELD VA
23234-7235
US

V. Phone/Fax

Practice location:
  • Phone: 804-918-2444
  • Fax: 804-918-2705
Mailing address:
  • Phone: 804-955-9259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WILLIAMS
Title or Position: OWNER
Credential: LPC, LSATP, MAC, SAP
Phone: 805-955-9259