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NPI Code Detail

MEDICARE: JULIA MAE BEASLEY

MEDICARE: JULIA MAE BEASLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor0710103843VA

General Provider Information

NPI Number : 1174308654
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA MAE BEASLEY
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number : 833-510-4357
Fax Number : 866-460-2997
Provider Business Practice Location Address
First Line : 4140 CROSSINGS CT STE 101-103
Second Line :
City : PRINCE GEORGE
State : VA
Zip : 23875-1538
Country : US
Telephone Number : 833-510-4357
Fax Number : 866-460-2997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2023
Last Update Date : 02/18/2026

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