Individual
GAVIN GRACE KANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1821 W BROADWAY AVE, MARYVILLE, TN 37801-5511
(865) 724-0852
(865) 724-0853
Mailing address
1821 W BROADWAY AVE, MARYVILLE, TN 37801-5511
(865) 724-0852
(865) 724-0853
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
Primary
10965
TN
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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