Provider Demographics
NPI:1245588722
Name:OTTERBEIN, BIANCA CABIT (MED, LPC, CACI)
Entity Type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:CABIT
Last Name:OTTERBEIN
Suffix:
Gender:F
Credentials:MED, LPC, CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3022
Mailing Address - Country:US
Mailing Address - Phone:803-552-2148
Mailing Address - Fax:
Practice Address - Street 1:1135 GREGG HWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6341
Practice Address - Country:US
Practice Address - Phone:803-641-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11021412101YA0400X
SC5381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)