Provider Demographics
NPI:1275122913
Name:EQUILIBRIUM MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:EQUILIBRIUM MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-616-7550
Mailing Address - Street 1:1212 YORK RD STE A302
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6245
Mailing Address - Country:US
Mailing Address - Phone:443-901-6235
Mailing Address - Fax:
Practice Address - Street 1:1212 YORK RD STE A302
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6245
Practice Address - Country:US
Practice Address - Phone:443-901-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)