Provider Demographics
NPI:1710406574
Name:DAVIS, CHASITY
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43113 POINTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-6497
Mailing Address - Country:US
Mailing Address - Phone:225-301-8118
Mailing Address - Fax:
Practice Address - Street 1:422 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6505
Practice Address - Country:US
Practice Address - Phone:225-922-0478
Practice Address - Fax:888-965-7288
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10270101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor