Provider Demographics
NPI:1376319293
Name:GRUVER, SAMANTHA NICHOLE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICHOLE
Last Name:GRUVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2225
Mailing Address - Country:US
Mailing Address - Phone:276-970-2075
Mailing Address - Fax:
Practice Address - Street 1:1027 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3942
Practice Address - Country:US
Practice Address - Phone:276-970-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician