Provider Demographics
NPI:1003472838
Name:DAVIS, CHAMELEON (DPC, LBSW, MAC, CMHT)
Entity type:Individual
Prefix:DR
First Name:CHAMELEON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPC, LBSW, MAC, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 BROWNING ROAD 520
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-6022
Mailing Address - Country:US
Mailing Address - Phone:662-757-0396
Mailing Address - Fax:
Practice Address - Street 1:1970 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5066
Practice Address - Country:US
Practice Address - Phone:662-227-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MSPH6485101YM0800X
MS101YP2500X, 101YM0800X
TN558104100000X
MSW11331104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker