Healthcare Provider Details

I. General information

NPI: 1871210435
Provider Name (Legal Business Name): SARAH MARIE KAVANAGH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 W LAKE LANSING RD STE 300B
EAST LANSING MI
48823-8465
US

IV. Provider business mailing address

3864 COUNTY FARM RD
SAINT JOHNS MI
48879-9296
US

V. Phone/Fax

Practice location:
  • Phone: 517-449-9155
  • Fax:
Mailing address:
  • Phone: 616-737-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: