Provider Demographics
NPI:1053744631
Name:ELLIS, IONA EVELYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:IONA
Middle Name:EVELYN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:IONA
Other - Middle Name:EVELYN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2034 SOUNDINGS CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:703-493-0891
Mailing Address - Fax:
Practice Address - Street 1:2034 SOUNDINGS CRESCENT CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:703-493-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0081401041C0700X
VA09040082471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical