Healthcare Provider Details

I. General information

NPI: 1013778760
Provider Name (Legal Business Name): ALL-IN-1 MENTAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ONTELL CT
STAFFORD VA
22554-1566
US

IV. Provider business mailing address

31 ONTELL CT
STAFFORD VA
22554-1566
US

V. Phone/Fax

Practice location:
  • Phone: 571-572-0050
  • Fax: 888-315-4281
Mailing address:
  • Phone: 571-572-0050
  • Fax: 888-315-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MAXIMO DE LA CRUZ
Title or Position: MANAGER
Credential:
Phone: 571-572-0050