Provider Demographics
NPI:1083353494
Name:NEBULA, SAGE LUNA (CADC-R, CRM)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:LUNA
Last Name:NEBULA
Suffix:
Gender:F
Credentials:CADC-R, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SE BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2916
Mailing Address - Country:US
Mailing Address - Phone:503-239-5738
Mailing Address - Fax:503-963-9026
Practice Address - Street 1:10230 SE CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2821
Practice Address - Country:US
Practice Address - Phone:503-535-1151
Practice Address - Fax:503-535-1190
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)