Provider Demographics
NPI:1093431504
Name:IMPACT COUNSELING, COACHING & CONSULTING LLC
Entity type:Organization
Organization Name:IMPACT COUNSELING, COACHING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD, LPC,
Authorized Official - Phone:757-354-3025
Mailing Address - Street 1:1000 REGENT UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5037
Mailing Address - Country:US
Mailing Address - Phone:757-354-3025
Mailing Address - Fax:
Practice Address - Street 1:1000 REGENT UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5037
Practice Address - Country:US
Practice Address - Phone:757-354-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083841779OtherCIGNA MEDICAL
VA1083841779OtherAETNA HEALTHKEEPERS PLUS
VA1083841779OtherAETNA BEHAVIORAL HEALTH
VA1083841779OtherMAGELLAN BEHAVIORAL HEALTH
VA1083841779OtherMOLINA COMPLETE CARE
VA1083841779Medicaid
VA1083841779OtherMAGELLAN
VA1083841779OtherMAGELLAN COMPLETE CARE
VA1083841779OtherPRIORITY HEALTH
VA1083841779OtherAETNA BETTER HEALTH
VA1083841779OtherCIGNA EAP
VA1083841779OtherOPTIMA
VA1083841779OtherAETNA
VA1083841779OtherANTHEM BLUE CROSS BLUE SHIELD
VA1083841779OtherSISCO
VA1083841779OtherCIGNA