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1447482237
JERRY V RIDGE
LAUREL, MS
NPI
1447482237
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MS AD01R-019R)
Enumeration Date
2009-08-13
Last Update Date
2009-08-13
Business Address
-- JERRY V RIDGE MADAC
7 LINE RD
LAUREL, MS 39443-2663
Phone number: 601-705-1901
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Mailing Address
-- JERRY V RIDGE MADAC
7 LINE RD
LAUREL, MS 39443-2663
Phone number: 601-705-1901
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