Provider Demographics
NPI:1760250724
Name:EQUIPOISE INTEGRAL COUNSELING
Entity Type:Organization
Organization Name:EQUIPOISE INTEGRAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:PAOLA
Authorized Official - Last Name:MAGLIOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CRC
Authorized Official - Phone:503-887-3608
Mailing Address - Street 1:821 NW 11TH AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3231
Mailing Address - Country:US
Mailing Address - Phone:503-887-3608
Mailing Address - Fax:503-809-5088
Practice Address - Street 1:ACTIVSPACE 1722 NW RALEIGH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-887-3608
Practice Address - Fax:503-809-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty