Healthcare Provider Details

I. General information

NPI: 1447004908
Provider Name (Legal Business Name): EQUANIMITY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 4TH ST NW
LOS RANCHOS NM
87107-6144
US

IV. Provider business mailing address

717 CANDELARIA RD NW APT S
ALBUQUERQUE NM
87107-2470
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-5911
  • Fax: 505-581-3303
Mailing address:
  • Phone: 505-226-5911
  • Fax: 505-581-3303

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: CHARLENE MCGINNIS
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 505-226-5911