Healthcare Provider Details

I. General information

NPI: 1003472838
Provider Name (Legal Business Name): CHAMELEON DAVIS DPC, LBSW, MAC, CMHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 GRANDVIEW DR
GRENADA MS
38901-5066
US

IV. Provider business mailing address

2504 BROWNING ROAD 520
GREENWOOD MS
38930-6022
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-3700
  • Fax:
Mailing address:
  • Phone: 662-757-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPH6485
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number558
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberW11331
License Number StateMS
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: