Provider Demographics
NPI:1134593965
Name:JEAN-LOUIS, MAXINE
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:JEAN-LOUIS
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 1:4321 JENA ST APT A
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4435
Mailing Address - Country:US
Mailing Address - Phone:407-982-6162
Mailing Address - Fax:
Practice Address - Street 1:2008 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-7000
Practice Address - Fax:540-689-7011
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13194104100000X
VA09040119371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker