Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Legacy 4 Change

Organization Clinical Social Worker · NPI 1912664509

Legacy 4 Change is a Clinical Social Worker in Jackson, Mississippi. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

2891 Terry Rd
Jackson, MS 39212-3051
Phone: (769) 203-8141
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1912664509
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Chasity Davis — President · (769) 203-8141
NPI enumeratedNovember 18, 2021
Last updated in NPPESJanuary 20, 2022
Certification dateJanuary 20, 2022
Mailing addressPo Box 821878, Vicksburg, MS 39182-1878

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