Individual
CODY TYLER GRUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1439 THUNDERBOLT DRIVE, WALTERBORO, SC 29488
(843) 538-4343
Mailing address
1439 THUNDERBOLT DRIVE, WALTERBORO, SC 29488
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101824814
SC
Other
Enumeration date
09/13/2021
Last updated
03/14/2022
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