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General NPI Number Information
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NPI Number | 1679930184
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Entity Type | Organization
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Legal Business Name | ELIZABETH C. GRUENEBERGER
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 519 LIVE OAK DR
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-4365
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Country | US
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Telephone | 843-971-8808
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Fax | 843-971-9636
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Provider Business Mailing Address
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Address Line | 519 LIVE OAK DR
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-4365
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Country | US
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Telephone | 843-971-8808
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Fax | 843-971-9636
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH C GRUENEBERGER
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Credential | M.D.
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Telephone | 843-971-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 31920
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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