Provider Demographics
NPI:1043949357
Name:KAVANAGH, GRACE MORGAN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MORGAN
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4062
Mailing Address - Country:US
Mailing Address - Phone:919-737-5938
Mailing Address - Fax:
Practice Address - Street 1:133 KEYBRIDGE DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5915
Practice Address - Country:US
Practice Address - Phone:919-737-5938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health