Provider Demographics
NPI:1891380127
Name:CRIST, VIRGINIA X (PHD, LMFT, DST)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:CRIST
Suffix:X
Gender:F
Credentials:PHD, LMFT, DST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 TILFORD X
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-2084
Mailing Address - Country:US
Mailing Address - Phone:561-212-6855
Mailing Address - Fax:
Practice Address - Street 1:1200 N. FEDERAL HWY., SUITE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-212-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist