Provider Demographics
NPI:1407552086
Name:KRUCHAKOV, CHRISTINA MARIE (MFTI)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KRUCHAKOV
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:SCALLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5550 S UNIVERSITY DR APT 7107
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5338
Mailing Address - Country:US
Mailing Address - Phone:850-687-3462
Mailing Address - Fax:
Practice Address - Street 1:915 MIDDLE RIVER DR STE 114
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3586
Practice Address - Country:US
Practice Address - Phone:954-368-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist