Provider Demographics
NPI:1407552086
Name:KRUCHAKOV, CHRISTINA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KRUCHAKOV
Suffix:
Gender:F
Credentials:LMFT
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 1:8304 GARDEN CATALINA CIR APT 717
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33467-6735
Practice Address - Country:US
Practice Address - Phone:850-687-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT5059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist