Provider Demographics
NPI:1639548753
Name:SEDAKA, LYCA CARROLL (MS, LMFT, LEP, NCSP)
Entity Type:Individual
Prefix:
First Name:LYCA
Middle Name:CARROLL
Last Name:SEDAKA
Suffix:
Gender:F
Credentials:MS, LMFT, LEP, NCSP
Other - Prefix:
Other - First Name:LYCA
Other - Middle Name:CARROLL
Other - Last Name:O'LOUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT, LEP, NCSP
Mailing Address - Street 1:2101 PEAR ST UNIT 358
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-6019
Mailing Address - Country:US
Mailing Address - Phone:925-725-9530
Mailing Address - Fax:
Practice Address - Street 1:3590 SAVAGE AVE
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1250
Practice Address - Country:US
Practice Address - Phone:510-717-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3632103TS0200X
CALMFT101200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool