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General NPI Number Information
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NPI Number | 1447004908
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Entity Type | Organization
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Legal Business Name | EQUANIMITY GROUP LLC
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Dates
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Enumeration Date | 04/12/2024
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 6666 4TH ST NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6144
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Country | US
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Telephone | 505-226-5911
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Fax | 505-581-3303
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Provider Business Mailing Address
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Address Line | 717 CANDELARIA RD NW APT S
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-2470
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Country | US
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Telephone | 505-226-5911
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Fax | 505-581-3303
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | CHARLENE MCGINNIS
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Credential | LCSW
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Telephone | 505-226-5911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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