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1295292274
CARROLL D. BLACKLEDGE
JACKSON, MS
NPI
1295292274
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: MS P-0512)
Enumeration Date
2019-02-26
Last Update Date
2019-02-26
Business Address
CARROLL D. BLACKLEDGE MA, P-LPC
4500 I 55 N STE 208
JACKSON, MS 39211-5931
Phone number: 601-405-7440
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Mailing Address
CARROLL D. BLACKLEDGE MA, P-LPC
107 LAUREL GLEN CT
MADISON, MS 39110-7395
Phone number: 601-622-7277
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