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Organization
EQUIPOISE INTEGRAL COUNSELING
Active
Organization
EQUIPOISE INTEGRAL COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVINIA PAOLA MAGLIOCCO MS CRC (PROFESSIONAL COUNSELOR)
(503) 887-3608
Entity
Organization
Contact information
Practice address
ACTIVSPACE 1722 NW RALEIGH ST, SUITE 201, PORTLAND, OR 97209
(503) 887-3608
(503) 809-5088
Mailing address
821 NW 11TH AVE APT 411, PORTLAND, OR 97209-3231
(503) 887-3608
(503) 809-5088
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
225600000X
Dance Therapist
—
NULL
225600000X
Dance Therapist
—
—
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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