Provider Demographics
NPI:1144112251
Name:MOULTRIE-MITCHELL, IKEA ERIKA (LGSW)
Entity type:Individual
Prefix:
First Name:IKEA
Middle Name:ERIKA
Last Name:MOULTRIE-MITCHELL
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:IKEA
Other - Middle Name:ERIKA
Other - Last Name:MOULTRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:9512 DALMATIA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4404
Mailing Address - Country:US
Mailing Address - Phone:201-316-0730
Mailing Address - Fax:
Practice Address - Street 1:801 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2167
Practice Address - Country:US
Practice Address - Phone:301-836-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD301611041C0700X
DCLG2000026741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical