Provider Demographics
NPI:1063043115
Name:MITCHELL, ERICA SYLVIA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:SYLVIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 HELEN POWER DR # 1020
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3504
Mailing Address - Country:US
Mailing Address - Phone:510-691-7171
Mailing Address - Fax:
Practice Address - Street 1:505 COURTLAND ST NE UNIT 1224
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2441
Practice Address - Country:US
Practice Address - Phone:510-691-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12885913-35011041C0700X
FLSW222601041C0700X
CA972801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical