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General NPI Number Information
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NPI Number | 1033653910
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Entity Type | Organization
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Legal Business Name | BIANCA JARDIN PHD LLC
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1050 JOHNNIE DODDS BLVD, #2381
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City | MT PLEASANT
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State | SC
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Zip | 29465-2801
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Country | US
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Telephone | 812-401-0941
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Fax | 843-480-9579
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Provider Business Mailing Address
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Address Line | 1050 JOHNNIE DODDS BLVD, # 2381
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City | MT PLEASANT
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State | SC
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Zip | 29465-2381
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Country | US
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Telephone | 812-401-0941
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Fax | 843-480-9579
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BIANCA JARDIN
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Credential | PHD
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Telephone | 812-401-0941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1285
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License Number State | SC
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