Healthcare Provider Details

I. General information

NPI: 1184589178
Provider Name (Legal Business Name): SAGE COLER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 BALBOA AVE
SAN DIEGO CA
92123-1592
US

IV. Provider business mailing address

2111 MANCHESTER AVE APT C
CARDIFF CA
92007-1826
US

V. Phone/Fax

Practice location:
  • Phone: 619-645-0139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61614747
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: