Provider Demographics
NPI:1225816572
Name:CHENAULT-ROBINSON, OCTAVIA R (MA, RLMHC, RA/MFT,)
Entity type:Individual
Prefix:MRS
First Name:OCTAVIA
Middle Name:R
Last Name:CHENAULT-ROBINSON
Suffix:
Gender:F
Credentials:MA, RLMHC, RA/MFT,
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 1:5441 S MACADAM AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:313-887-0087
Practice Address - Fax:313-887-4112
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6853088696171M00000X, 171M00000X
ORR11398106H00000X
WAMHCAMC61625623101Y00000X
MI2024375172V00000X
FLIMH27042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty