Provider Demographics
NPI:1144504374
Name:DEVINE, CRISTIN ELISE (MED, MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:CRISTIN
Middle Name:ELISE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:MED, MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26485 CARMEL RANCHO BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923
Mailing Address - Country:US
Mailing Address - Phone:831-233-0834
Mailing Address - Fax:
Practice Address - Street 1:26485 CARMEL RANCHO BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8706
Practice Address - Country:US
Practice Address - Phone:831-233-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist