J. Kellie Young Evans, LCSW,CSTOP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

1805 Airline Blvd
Portsmouth, VA 23707-3912

Phone

(757) 397-2121

Fax

(757) 399-3316

NPI assigned

Dec 20, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  VA

  Medicare reassignment Care Compare group NPD
• Child and Family Services of Eastern Virginia

  • Mental Health Counselor
  • Portsmouth, VA
  • NPI 1487867776
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033273560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 AIRLINE BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073912",
            "telephone_number": "757-397-2121",
            "fax_number": "757-399-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 AIRLINE BLVD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073912",
            "telephone_number": "757-397-2121",
            "fax_number": "757-399-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "J. KELLIE",
        "middle_name": "YOUNG",
        "credential": "LCSW,CSTOP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Espejo
• Essential Family Services, LLC
• Latoya Monique Essrhir, RN
• Terrilyn Etheridge, PHYSICAL THERAPIST
• Daniel Kyle Evans, IDC
• John Porter Evans, PSY. D.
• Michael Steven Evans, RPH
• Terri Jaclena Evans
• Everett Service Provider
• Everforward Community Counseling Services, Inc

• Clinical Social Worker in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.