Provider Demographics
NPI:1457159311
Name:WORKMAN, OCTAVIA JOY
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:JOY
Last Name:WORKMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8785 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6209
Mailing Address - Country:US
Mailing Address - Phone:440-701-6590
Mailing Address - Fax:
Practice Address - Street 1:8785 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6209
Practice Address - Country:US
Practice Address - Phone:440-701-6590
Practice Address - Fax:440-701-8115
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.188439101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)