Provider Demographics
NPI:1295194777
Name:MITCHELL, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
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 1:2804 DEL PRADO BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904
Mailing Address - Country:US
Mailing Address - Phone:239-257-1504
Mailing Address - Fax:
Practice Address - Street 1:2804 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 106
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7252
Practice Address - Country:US
Practice Address - Phone:239-257-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker