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General NPI Number Information
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NPI Number | 1033698634
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Entity Type | Individual
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Provider Name | THEODORE ANDREW RUBLE
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Gender | Male
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 10825 DORCHESTER RD APT 1072
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City | SUMMERVILLE
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State | SC
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Zip | 29485-6051
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Country | US
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Telephone | 301-733-2431
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Fax |
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Provider Business Mailing Address
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Address Line | 322 E ANTIETAM ST STE 101
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8152
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License Number State | SC
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