Provider Demographics
NPI:1326713322
Name:GRUBB, RYAN MATTHEW I
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:GRUBB
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 COMMONWEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1894
Mailing Address - Country:US
Mailing Address - Phone:434-205-6776
Mailing Address - Fax:
Practice Address - Street 1:2300 COMMONWEALTH DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1894
Practice Address - Country:US
Practice Address - Phone:434-205-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07040110343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional