Provider Demographics
NPI:1104106327
Name:MITCHELL, ERNEST III (MDIV, EDS)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:MITCHELL
Suffix:III
Gender:M
Credentials:MDIV, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 NOTTINGHAM WAY STE L2
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1814
Mailing Address - Country:US
Mailing Address - Phone:609-367-4699
Mailing Address - Fax:609-871-1498
Practice Address - Street 1:2733 NOTTINGHAM WAY STE L2
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1814
Practice Address - Country:US
Practice Address - Phone:609-367-4699
Practice Address - Fax:609-871-1498
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3TP11-019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist