Ebony R Davis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15083SW Issued in FL

Practice address

5422 Cresta Way
Jacksonville, FL 32211-5515

Phone

(904) 338-1259

Fax

(904) 212-2509

NPI assigned

Jan 26, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, GA2 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

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Ebtide Counseling LLCGroup PAC ID 3779820840, 2 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Ebtide Counseling LLC

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1588139380
  Medicare reassignment Care Compare group NPD Authorized official
• Ebtide Counseling Group, Inc

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1144871351

  GA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1516924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1891293692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2384",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322032384",
            "telephone_number": "904-338-1259",
            "fax_number": "904-212-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5422 CRESTA WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322115515",
            "telephone_number": "904-338-1259",
            "fax_number": "904-212-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "EBONY",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-26",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW15083",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "15083SW",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Ann Davis, ARNP
• Deborah Ann Davis, LMHC
• Deidra D Davis, LCSW
• Desiree Chrissaundra Davis
• Dillon Alexander Davis, D.M.D
• Elizabeth Anne Davis
• Erica Davis
• Homesha Davis
• Hoover Davis III, CAP
• Jack Mathew Davis, IMH

• Clinical Social Worker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2018; 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.