| Legacy 4 Change | |
|
2891 Terry Rd Jackson MS 39212-3051 | |
| (769) 203-8141 | |
| Not Available |
| Full Name | Legacy 4 Change |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2891 Terry Rd, Jackson, Mississippi |
| Authorized Official Name and Position | Chasity Davis (PRESIDENT) |
| Authorized Official Contact | 7692038141 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy 4 Change Po Box 821878 Vicksburg MS 39182-1878 Ph: (769) 203-8141 | Legacy 4 Change 2891 Terry Rd Jackson MS 39212-3051 Ph: (769) 203-8141 |
| NPI Number | 1912664509 |
|---|---|
| Provider Enumeration Date | 11/18/2021 |
| Last Update Date | 01/20/2022 |
| Certification Date | 01/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912664509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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