Provider Demographics
NPI:1003644030
Name:EQUANIMITY INTEGRATED BEHAVIORAL HEALTH & WELLNESS
Entity type:Organization
Organization Name:EQUANIMITY INTEGRATED BEHAVIORAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DEGRAFENREID
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNP, PMHNP-BC, FNP-
Authorized Official - Phone:443-708-8139
Mailing Address - Street 1:7500 HARFORD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6900
Mailing Address - Country:US
Mailing Address - Phone:443-251-2100
Mailing Address - Fax:240-241-6360
Practice Address - Street 1:1001 CROMWELL BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3329
Practice Address - Country:US
Practice Address - Phone:443-251-2100
Practice Address - Fax:240-241-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty