Provider Demographics
NPI:1780315465
Name:DEWEERDT, BIANCA NICOLE (CPCINTERN)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:NICOLE
Last Name:DEWEERDT
Suffix:
Gender:F
Credentials:CPCINTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 JUBILATION DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5419
Mailing Address - Country:US
Mailing Address - Phone:702-372-6565
Mailing Address - Fax:
Practice Address - Street 1:2920 S JONES BLVD STE 225
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5622
Practice Address - Country:US
Practice Address - Phone:702-476-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health