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General NPI Number Information
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NPI Number | 1093431504
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Entity Type | Organization
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Legal Business Name | IMPACT COUNSELING, COACHING & CONSULTING LLC
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 1000 REGENT UNIVERSITY DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-5037
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Country | US
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Telephone | 757-354-3025
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 REGENT UNIVERSITY DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-5037
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Country | US
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Telephone | 757-354-3025
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL SUPERVISOR
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Name | DR. CYRUS WILLIAMS III
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Credential | PHD, LPC,
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Telephone | 757-354-3025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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