Healthcare Provider Details

I. General information

NPI: 1225816572
Provider Name (Legal Business Name): OCTAVIA R CHENAULT-ROBINSON MA, RLMHC,R/MFT,LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

PO BOX 80774
SAINT CLAIR SHORES MI
48080-5774
US

V. Phone/Fax

Practice location:
  • Phone: 313-887-0087
  • Fax: 313-887-4112
Mailing address:
  • Phone: 313-887-0087
  • Fax: 313-887-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMHCAMC61625623
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27042
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023868
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR11398
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: