Individual
TRACEY KAVANAGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1000 RIVERSIDE AVE STE 312, JACKSONVILLE, FL 32204-4174
(904) 318-2258
(904) 808-1472
Mailing address
196 APPIAN AVE, SAINT AUGUSTINE, FL 32092-0040
(904) 318-2258
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MH4678
FL
Other
Enumeration date
07/16/2006
Last updated
12/05/2023
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