Healthcare Provider Details

I. General information

NPI: 1962740613
Provider Name (Legal Business Name): LUCY B OBERG CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 J ST
SACRAMENTO CA
95811-3010
US

IV. Provider business mailing address

1820 J ST
SACRAMENTO CA
95811-3010
US

V. Phone/Fax

Practice location:
  • Phone: 916-550-5481
  • Fax:
Mailing address:
  • Phone: 916-550-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI13500418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: