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Provider Information for 1295856110


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DAVINA KAVANAUGH LLPC


Sex: Female

NPI: 1295856110
Last Updated: 2009-10-28
Certification Date:

Details

NameValue
NPI1295856110
Enumeration Date2007-04-02
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 3718 OLNEY RD
KALAMAZOO, MI 49006-2863
United States

Phone: 269-344-0747 | Fax:269-226-0748
 
Primary Practice Address 148 N RIVERVIEW DR
PARCHMENT, MI 49004-1308
United States

Phone: 269-344-0747 | Fax:269-226-0748
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalMI6401009378