Healthcare Provider Details

I. General information

NPI: 1255268561
Provider Name (Legal Business Name): JULIA SELF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 STAPLES MILL ROAD
RICHMOND VA
23230
US

IV. Provider business mailing address

11564 RICHMOND RD
WARSAW VA
22572-3471
US

V. Phone/Fax

Practice location:
  • Phone: 804-724-3733
  • Fax:
Mailing address:
  • Phone: 804-724-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012848
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: