Healthcare Provider Details

I. General information

NPI: 1275051005
Provider Name (Legal Business Name): KENYA JACOBIE DEQUANE ROBINSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 MACARTHUR AVE
DALLAS TX
75209-6511
US

IV. Provider business mailing address

7510 FM 1886
AZLE TX
76020-1054
US

V. Phone/Fax

Practice location:
  • Phone: 214-526-4525
  • Fax:
Mailing address:
  • Phone: 817-448-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number75098
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75098
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: