# MAXIMO DELACRUZ CENTRO D SALUD MENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MAXIMO Delacruz Centro D Salud Mental LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205607744
- **Authorized official:** MR. MAXIMO DE LA CRUZ BA-MA (OWNER/DIRECTOR)
- **Authorized official phone:** (571) 572-0050

## Contact information

- **Practice address:** 31 ONTELL CT, STAFFORD, VA 22554-1566
- **Practice address phone:** (571) 572-0050
- **Practice address fax:** (888) 315-4281
- **Mailing address:** 31 ONTELL CT, STAFFORD, VA 22554-1566
- **Mailing address phone:** (571) 572-0050
- **Mailing address fax:** (888) 315-4281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 01/12/2024
- **Last updated:** 01/12/2024