Provider Demographics
NPI:1689340358
Name:MAXWELL, VIRGINIA CHERIE
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CHERIE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S MICHIGAN AVE STE 1700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3353
Mailing Address - Country:US
Mailing Address - Phone:872-895-7942
Mailing Address - Fax:800-391-8460
Practice Address - Street 1:8 S MICHIGAN AVE STE 1700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3353
Practice Address - Country:US
Practice Address - Phone:872-895-7942
Practice Address - Fax:800-391-8460
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician