NPIMap

Organization Active NPI

Legacy 4 Change

  • Clinical Social Worker
  • Jackson, MS
National Provider Identifier
1912664509
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LEGACY 4 CHANGE
Practice address
2891 Terry Rd
Jackson, MS 39212-3051
Phone
(769) 203-8141
NPI assigned
Nov 18, 2021
Last updated
Jan 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chasity DavisNPI 1215138946
Title
President
Phone
(769) 203-8141

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

2891 Terry Rd
Jackson, MS 39212-3051

Mailing address

PO Box 821878
Vicksburg, MS 39182-1878
Phone (769) 203-8141

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1912664509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 821878",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391821878",
            "telephone_number": "769-203-8141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2891 TERRY RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392123051",
            "telephone_number": "769-203-8141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY 4 CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-18",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CHASITY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "769-203-8141"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.