{
"Npi": {
"NPI": "1053744631",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ELLIS",
"FirstName": "IONA",
"MiddleName": "EVELYN",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "LCSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WALKER",
"OtherFirstName": "IONA",
"OtherMiddleName": "EVELYN",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "LCSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2034 SOUNDINGS CRESCENT CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUFFOLK",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-493-0891",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2034 SOUNDINGS CRESCENT CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUFFOLK",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23435",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-493-0891",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/19/2013",
"LastUpdateDate": "05/16/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "C008140",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "0904008247",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}