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General NPI Number Information
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NPI Number | 1083353494
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Entity Type | Individual
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Provider Name | SAGE LUNA NEBULA CADC-II, QMHA, CRM
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Gender | Female
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 10822 SE 82ND AVE STE K
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-7658
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Country | US
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Telephone | 503-654-7444
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Fax | 503-654-0392
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Provider Business Mailing Address
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Address Line | 1027 E BURNSIDE ST
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City | PORTLAND
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State | OR
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Zip | 97214-1328
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Country | US
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Telephone | 503-239-8400
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Fax | 503-239-8406
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | OR
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