Provider Demographics
NPI:1508497017
Name:MITCHELL, ERICA DANESE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DANESE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:ELAINE
Other - Last Name:DANESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8540 BAYCENTER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7420
Mailing Address - Country:US
Mailing Address - Phone:904-394-5703
Mailing Address - Fax:
Practice Address - Street 1:8540 BAYCENTER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7420
Practice Address - Country:US
Practice Address - Phone:904-448-1933
Practice Address - Fax:904-448-0349
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker