Individual
CARROLL D. BLACKLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, P-LPC
Contact information
Practice address
4500 I 55 N STE 208, JACKSON, MS 39211-5931
(601) 405-7440
Mailing address
107 LAUREL GLEN CT, MADISON, MS 39110-7395
(601) 622-7277
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P-0512
MS
Other
Enumeration date
02/26/2019
Last updated
02/26/2019
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