Equilibrium LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4644 Issued in SC

Legal business name

EQUILIBRIUM LLC

Practice address

701 Gervais St
Ste 150-258
Columbia, SC 29201-3066

Phone

(803) 361-3066

Fax

(866) 834-4286

NPI assigned

Apr 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wendy K Graham, EDS LPC

Title

Licensed Professional Counselor

Phone

(803) 361-3066

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013135433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 PICKENS ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012630",
            "telephone_number": "803-361-3066",
            "fax_number": "866-834-4286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GERVAIS ST",
            "address_2": "STE 150-258",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292013066",
            "telephone_number": "803-361-3066",
            "fax_number": "866-834-4286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EQUILIBRIUM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "18033613066",
        "authorized_official_credential": "EDS LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "4644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI LPC",
            "identifier": "1730137456",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Columbia, SC
• Providers in Columbia, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.