Provider Demographics
NPI:1063871416
Name:EQUILIBRIUM LLC
Entity type:Organization
Organization Name:EQUILIBRIUM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:VONIE'
Authorized Official - Last Name:STILLSON
Authorized Official - Suffix:
Authorized Official - Credentials:BC-DMT, LPC, ACS, NB
Authorized Official - Phone:970-599-1314
Mailing Address - Street 1:330 N LINCOLN AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5600
Mailing Address - Country:US
Mailing Address - Phone:970-599-1314
Mailing Address - Fax:
Practice Address - Street 1:330 N LINCOLN AVE
Practice Address - Street 2:STE 108
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5600
Practice Address - Country:US
Practice Address - Phone:970-599-1314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-13
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1899101YM0800X
COLPC.0012986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty