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General NPI Number Information
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NPI Number | 1639548753
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Entity Type | Individual
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Provider Name | LYCA CARROLL SEDAKA M.S, LMFT, LEP, NCSP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 3590 SAVAGE AVE
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City | PINOLE
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State | CA
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Zip | 94564-1250
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Country | US
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Telephone | 510-717-5740
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 PEAR ST UNIT 358
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City | PINOLE
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State | CA
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Zip | 94564-6019
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Country | US
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Telephone | 925-725-9530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | LEP3632
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT101200
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License Number State | CA
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