Healthcare Provider Details

I. General information

NPI: 1821938150
Provider Name (Legal Business Name): CLARISSA HASKINS-MAXEY MSW, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11357 NUCKOLS RD # 2002
GLEN ALLEN VA
23059-5504
US

IV. Provider business mailing address

11357 NUCKOLS RD # 2002
GLEN ALLEN VA
23059-5504
US

V. Phone/Fax

Practice location:
  • Phone: 434-808-2278
  • Fax: 443-451-8214
Mailing address:
  • Phone: 434-808-2278
  • Fax: 443-451-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103941
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906016743
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: