Provider Demographics
NPI:1003472838
Name:DAVIS, CHAMELEON (DPC, LBSW, MAC)
Entity Type:Individual
Prefix:DR
First Name:CHAMELEON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPC, LBSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 SHARKEY RD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:MS
Mailing Address - Zip Code:38928-2565
Mailing Address - Country:US
Mailing Address - Phone:662-757-0396
Mailing Address - Fax:
Practice Address - Street 1:1361 SHARKEY RD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:MS
Practice Address - Zip Code:38928-2565
Practice Address - Country:US
Practice Address - Phone:662-902-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN558104100000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker