Provider Demographics
NPI:1861369977
Name:ABSOLUTE MENTAL HEALTH CLINIC LLC
Entity type:Organization
Organization Name:ABSOLUTE MENTAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIMO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA-MA-QMHP
Authorized Official - Phone:571-572-0050
Mailing Address - Street 1:1930 OPITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3304
Mailing Address - Country:US
Mailing Address - Phone:571-572-0050
Mailing Address - Fax:888-315-4281
Practice Address - Street 1:1930 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3304
Practice Address - Country:US
Practice Address - Phone:571-398-2758
Practice Address - Fax:888-315-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center