Healthcare Provider Details

I. General information

NPI: 1699619585
Provider Name (Legal Business Name): LACUNA COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 NW PORTLAND AVE APT 11
BEND OR
97703-1544
US

IV. Provider business mailing address

1215 NW PORTLAND AVE APT 11
BEND OR
97703-1544
US

V. Phone/Fax

Practice location:
  • Phone: 781-679-1943
  • Fax:
Mailing address:
  • Phone: 781-679-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY HOPKINSON
Title or Position: OWNER
Credential: LMHC,LPC
Phone: 781-679-1943