Provider Demographics
NPI:1285064956
Name:JARDIN, BIANCA (PHD)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:
Last Name:JARDIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 JOHNNIE DODDS BLVD., # 2381
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-2381
Mailing Address - Country:US
Mailing Address - Phone:812-401-0941
Mailing Address - Fax:843-480-9579
Practice Address - Street 1:1050 JOHNNIE DODDS BLVD., # 2381
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29465-2381
Practice Address - Country:US
Practice Address - Phone:812-401-0941
Practice Address - Fax:843-480-9579
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0540Medicaid