Healthcare Provider Details

I. General information

NPI: 1801750120
Provider Name (Legal Business Name): EQUILIBRIUM COACHING AND SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CALAIS AVE
CALAIS ME
04619-1664
US

IV. Provider business mailing address

61 CALAIS AVE
CALAIS ME
04619-1664
US

V. Phone/Fax

Practice location:
  • Phone: 207-214-2163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALAINA WILLSON
Title or Position: OWNER
Credential:
Phone: 207-214-2163