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General NPI Number Information
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NPI Number | 1861369977
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Entity Type | Organization
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Legal Business Name | ABSOLUTE MENTAL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1930 OPITZ BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3304
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Country | US
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Telephone | 571-398-2758
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Fax | 888-315-4281
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Provider Business Mailing Address
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Address Line | 1930 OPITZ BLVD
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3304
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Country | US
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Telephone | 571-572-0050
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Fax | 888-315-4281
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Authorized Official
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Title or Position | CHIEF DIRECTOR
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Name | MR. MAXIMO DE LA CRUZ
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Credential | BA-MA-QMHP
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Telephone | 571-572-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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