Healthcare Provider Details

I. General information

NPI: 1821817800
Provider Name (Legal Business Name): HEATHER MARIA MAXION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NAAMANS RD STE 110
CLAYMONT DE
19703-2301
US

IV. Provider business mailing address

15 LOCH LOMOND ST
BEAR DE
19701-4711
US

V. Phone/Fax

Practice location:
  • Phone: 302-224-1400
  • Fax:
Mailing address:
  • Phone: 302-409-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: