Healthcare Provider Details

I. General information

NPI: 1588596332
Provider Name (Legal Business Name): MAXXAMIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 RIDGEFIELD DR
SLIDELL LA
70458-7326
US

IV. Provider business mailing address

728 RIDGEFIELD DR
SLIDELL LA
70458-7326
US

V. Phone/Fax

Practice location:
  • Phone: 504-416-2551
  • Fax:
Mailing address:
  • Phone: 504-416-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MAKITHA RICHARDS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSW
Phone: 504-416-2551