Provider Demographics
NPI:1700572906
Name:RUCKER, BIANCA LAUREN
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:LAUREN
Last Name:RUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BIANCA
Other - Middle Name:LAUREN
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:325 E UNIVERSITY BLVD APT 170
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7071
Mailing Address - Country:US
Mailing Address - Phone:321-662-0008
Mailing Address - Fax:
Practice Address - Street 1:391 COMMERCE PKWY STE 220
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4209
Practice Address - Country:US
Practice Address - Phone:321-258-9537
Practice Address - Fax:321-541-9135
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health