Provider Demographics
NPI:1922610054
Name:HERNANDEZ, BIANCA L (LLMSW)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2358
Mailing Address - Country:US
Mailing Address - Phone:989-572-0246
Mailing Address - Fax:
Practice Address - Street 1:210 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2358
Practice Address - Country:US
Practice Address - Phone:989-244-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801106836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty