Provider Demographics
NPI:1467987974
Name:CALLOWAY, EBONY NICOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:NICOLE
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16712 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2115
Mailing Address - Country:US
Mailing Address - Phone:703-221-7467
Mailing Address - Fax:703-221-4115
Practice Address - Street 1:16712 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2115
Practice Address - Country:US
Practice Address - Phone:703-221-7467
Practice Address - Fax:703-221-4115
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW123571041C0700X
DCLC500804281041C0700X
VA09040103391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical