# EQUIPOISE INTEGRAL COUNSELING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760250724
- **Authorized official:** LAVINIA PAOLA MAGLIOCCO MS CRC (PROFESSIONAL COUNSELOR)
- **Authorized official phone:** (503) 887-3608

## Contact information

- **Practice address:** ACTIVSPACE 1722 NW RALEIGH ST, SUITE 201, PORTLAND, OR 97209
- **Practice address phone:** (503) 887-3608
- **Practice address fax:** (503) 809-5088
- **Mailing address:** 821 NW 11TH AVE APT 411, PORTLAND, OR 97209-3231
- **Mailing address phone:** (503) 887-3608
- **Mailing address fax:** (503) 809-5088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 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