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General NPI Number Information
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NPI Number | 1265066922
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Entity Type | Individual
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Provider Name | SEAN KAVANAGH LCDC
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Gender | Male
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 3330 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-4531
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Country | US
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Telephone | 214-371-0474
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Fax |
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Provider Business Mailing Address
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Address Line | 737 E GRAND AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4404
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Country | US
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Telephone | 760-745-8478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17560
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License Number State | TX
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