Provider Demographics
NPI:1437683984
Name:COLINA, CRYSTAL D (MSW, LCSW, MCAPI)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:COLINA
Suffix:
Gender:F
Credentials:MSW, LCSW, MCAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 SW SULTAN DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2645
Mailing Address - Country:US
Mailing Address - Phone:864-275-8398
Mailing Address - Fax:
Practice Address - Street 1:2801 SE MARTIN SQUARE CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4916
Practice Address - Country:US
Practice Address - Phone:772-444-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FLSW151271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)