Provider Demographics
NPI:1821552357
Name:KURUDIMOVA, ALLA (LMFT 125826)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:KURUDIMOVA
Suffix:
Gender:F
Credentials:LMFT 125826
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3875
Mailing Address - Country:US
Mailing Address - Phone:916-613-0684
Mailing Address - Fax:
Practice Address - Street 1:1104 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3875
Practice Address - Country:US
Practice Address - Phone:916-613-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT125826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist