Most Relevant Information
Provider Data
| NPI Number: | 1003472838 |
| Provider Name: | CHAMELEON DAVIS DPC, LBSW, MAC |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | 558 |
Most Important Dates
| Enumeration Date: | 05/16/2019 |
| Last Updated: | 12/16/2020 |
Provider Practice Location
1361 SHARKEY RD
GLENDORA
MS
389282565
Practice Location Phone/Fax
| Phone: | 6629029833 |
| Fax: |
Provider Mailing Location
1361 SHARKEY RD
GLENDORA
MS
389282565
Provider Mailing Phone/Fax
| Phone: | 6627570396 |
| Fax: |