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Organization
RUSTIC SAGE LLC
Active
Organization
RUSTIC SAGE LLC
Active
Other names
Rustic Sage LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE B PRUITT LCSW (OWNER)
(503) 860-1213
Entity
Organization
Contact information
Practice address
1220 SW MORRISON ST STE 730, PORTLAND, OR 97205-2226
(503) 860-1213
(844) 889-4937
Mailing address
PO BOX 4162, PORTLAND, OR 97208-4162
(503) 860-1213
(844) 889-4937
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
NULL
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/16/2021
Last updated
06/20/2024
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