Provider Demographics
NPI:1225816572
Name:CHENAULT-ROBINSON, OCTAVIA R (MA, LLPC, RHMCI, LST)
Entity type:Individual
Prefix:MRS
First Name:OCTAVIA
Middle Name:R
Last Name:CHENAULT-ROBINSON
Suffix:
Gender:
Credentials:MA, LLPC, RHMCI, LST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80774
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-5774
Mailing Address - Country:US
Mailing Address - Phone:313-887-0087
Mailing Address - Fax:313-887-4112
Practice Address - Street 1:PO BOX 80774
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-5774
Practice Address - Country:US
Practice Address - Phone:734-548-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6853088696174400000X, 104100000X, 171M00000X
MI2024375172V00000X
MI0000000000000001101Y00000X
FLIMH27042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator