Individual provider Active NPI

Maximo De la Cruz, QMHP-A-MA

  • Mental Health Counselor
  • Manassas, VA
National Provider Identifier
1043875248
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
7530 Diplomat Dr Ste 101
Manassas, VA 20109-2682
Phone
(571) 572-0050
Fax
(888) 315-4281
NPI assigned
May 3, 2019
Last updated
Jan 20, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X VA Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 3329-05-001 VA
Adolescent and Children Mental Health Clinic/Center 261QM0855X 3329 VA

Addresses

Primary practice location

7530 Diplomat Dr Ste 101
Manassas, VA 20109-2682

Mailing address

31 Ontell CT
Stafford, VA 22554-1566
Phone (571) 572-0050

Other practice location 1

31 Ontell Ct
Stafford, VA 22554-1566
Phone (571) 572-0050

Other practice location 2

1930 Opitz Blvd
Woodbridge, VA 22191-3304
Phone (571) 572-0050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260217001089 VA Practitioner - Mental Health Counselor 8729568985 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2002
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1303 Florida Ave
Woodbridge, VA 22191-3620

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3329VAMDAdolescent and Children Mental Health Clinic/Center

Practice roles

OrganizationSpecialtyStatusNew patients
Absolute Mental Health Clinic LLC Adolescent and Children Mental Health CurrentSince Nov 1, 2025 Accepting new patients
Absolute Mental Health Clinic LLC Current Accepting new patients

Locations

1930 Opitz Blvd
Woodbridge, VA 22191
Phone (703) 497-9950

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768867200000",
    "number": "1043875248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 ONTELL CT",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225541566",
            "telephone_number": "571-572-0050",
            "fax_number": "888-315-4281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7530 DIPLOMAT DR STE 101",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092682",
            "telephone_number": "571-572-0050",
            "fax_number": "888-315-4281"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 Ontell Ct",
            "address_purpose": "LOCATION",
            "city": "Stafford",
            "state": "VA",
            "postal_code": "225541566",
            "country_code": "US",
            "telephone_number": "571-572-0050",
            "fax_number": "888-315-4281",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1930 Opitz Blvd",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221913304",
            "country_code": "US",
            "telephone_number": "571-572-0050",
            "fax_number": "888-315-4281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA CRUZ",
        "first_name": "MAXIMO",
        "name_prefix": "Mr.",
        "credential": "QMHP-A-MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-03",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "VA",
            "license": "3329-05-001",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "VA",
            "license": "3329",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

Verify at the official NPI Registry.