Healthcare Provider Details

I. General information

NPI: 1215138946
Provider Name (Legal Business Name): CHASITY DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHASITY DAVIS

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CANEBRAKE BLVD STE 110-17
FLOWOOD MS
39232-2211
US

IV. Provider business mailing address

PO BOX 821878
VICKSBURG MS
39182-1878
US

V. Phone/Fax

Practice location:
  • Phone: 919-339-1854
  • Fax:
Mailing address:
  • Phone: 769-203-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149022718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: