Provider Demographics
NPI:1790944676
Name:CHAMBERLIN-ELLIOTT, DAVIDA JO (MA LCDC)
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:JO
Last Name:CHAMBERLIN-ELLIOTT
Suffix:
Gender:F
Credentials:MA LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 DEVEREUX DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2043
Mailing Address - Country:US
Mailing Address - Phone:281-316-5410
Mailing Address - Fax:281-316-5498
Practice Address - Street 1:1150 DEVEREUX DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2043
Practice Address - Country:US
Practice Address - Phone:281-316-5410
Practice Address - Fax:281-316-5498
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7652101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)