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General NPI Number Information
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NPI Number | 1366878084
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Entity Type | Individual
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Provider Name | ERIK MITCHELL LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 3911 CONCORD PIKE BOX 7811
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City | WILMINGTON
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State | DE
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Zip | 19803-1736
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Country | US
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Telephone | 123-456-7890
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7811
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City | WILMINGTON
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State | DE
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Zip | 19803-0811
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW128063
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CW016737
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW128063
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016737
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License Number State | DE
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