Ebony Nicole Calloway, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010339 Issued in VA

Practice address

16712 Jefferson Davis Hwy
Dumfries, VA 22026-2115

Phone

(703) 221-7467

Fax

(703) 221-4115

NPI assigned

Apr 22, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Minuteclinic Diagnostic of Virginia LLC

  • Family Nurse Practitioner
  • Leesburg, VA
  • NPI 1417076829

  Clinical

  Medicare reassignment NPD
• Supportive Care of Virginia LLC

  • Clinical Psychologist
  • Colonial Heights, VA
  • NPI 1801485354
  Medicare reassignment NPD
• Supportive Care of Maryland LLC

  • Psychologist
  • Riverdale, MD
  • NPI 1447802616

  DC

  Medicare reassignment NPD
• Della Behavioral Health Services

  dba CounterPoint Health Services

  • Psychologist
  • Columbia, MD
  • NPI 1750635207

  DC

  Medicare reassignment

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

{
    "created_epoch": "1492819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1467987974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16712 JEFFERSON DAVIS HWY",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220262115",
            "telephone_number": "703-221-7467",
            "fax_number": "703-221-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16712 JEFFERSON DAVIS HWY",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220262115",
            "telephone_number": "703-221-7467",
            "fax_number": "703-221-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLOWAY",
        "first_name": "EBONY",
        "middle_name": "NICOLE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-22",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW12357",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50080428",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candice Lashey Bryant
• Miriam C. Bryant, PMHNP-BC
• Leslie Jean Buckley
• Mina Bulatovic
• Peterson Cadeau, RBT
• Calmay Audiology LLC (Ascent Audiology and Hearing)
• Katherine Marie Campbell, DPT
• Mary E Campise
• Carrington Developmental Support Services LLC
• Kimberly Carter, PSY.D.

• Clinical Social Worker in Dumfries, VA
• Providers in Dumfries, 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 Mar 14, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.