Healthcare Provider Details

I. General information

NPI: 1255243648
Provider Name (Legal Business Name): BIANCA BAKARDIEVA RAMOS DA SILVA MA, LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3797 GLACIER CIR
MINNETRISTA MN
55375-1352
US

IV. Provider business mailing address

3797 GLACIER CIR
MINNETRISTA MN
55375-1352
US

V. Phone/Fax

Practice location:
  • Phone: 612-425-9994
  • Fax:
Mailing address:
  • Phone: 612-425-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC05460
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: