Individual
JERRY V RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MADAC
Contact information
Practice address
7 LINE RD, LAUREL, MS 39443-2663
(601) 705-1901
Mailing address
7 LINE RD, LAUREL, MS 39443-2663
(601) 705-1901
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AD01R-019R
MS
Other
Enumeration date
08/13/2009
Last updated
05/03/2026
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