Organization
ABSOLUTE MENTAL HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAXIMO DE LA CRUZ BA-QMHP-C-MA (CHIEF DIRECTOR)
(571) 572-0050
Entity
Organization
Contact information
Practice address
1303 FLORIDA AVE, WOODBRIDGE, VA 22191-3620
(571) 398-2758
Mailing address
1930 OPITZ BLVD, WOODBRIDGE, VA 22191-3304
(571) 398-2758
(888) 315-4281
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201509030074274
CERTIFICATE OF ASSUMED OR FICTITIOUS NAME
VA
Enumeration date
05/03/2019
Last updated
11/21/2025
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