Healthcare Provider Details

I. General information

NPI: 1720902323
Provider Name (Legal Business Name): SWEET OAK THERAPY LICENSED CLINICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260B 45TH ST
EMERYVILLE CA
94608-2907
US

IV. Provider business mailing address

1260B 45TH ST
EMERYVILLE CA
94608-2907
US

V. Phone/Fax

Practice location:
  • Phone: 510-345-1474
  • Fax:
Mailing address:
  • Phone:
  • 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: GABRIELLE THEOBALD-ANDERSON
Title or Position: OWNER
Credential: LCSW
Phone: 510-345-1474