Healthcare Provider Details

I. General information

NPI: 1295699700
Provider Name (Legal Business Name): MAXWELL COMMUNITY CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 BEECHMONT DR
NEWPORT NEWS VA
23608-2759
US

IV. Provider business mailing address

359 BEECHMONT DR
NEWPORT NEWS VA
23608-2759
US

V. Phone/Fax

Practice location:
  • Phone: 757-255-8607
  • Fax:
Mailing address:
  • Phone: 757-255-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MATTIELOU GILLIAM
Title or Position: OWNER
Credential:
Phone: 757-255-8607