Healthcare Provider Details

I. General information

NPI: 1396337812
Provider Name (Legal Business Name): OLIVIA GREENWALD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

V. Phone/Fax

Practice location:
  • Phone: 619-736-8361
  • Fax:
Mailing address:
  • Phone: 619-736-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number12452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: