CARROLL D. BLACKLEDGE (NPI# 1295292274) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295292274 |
| Entity Type | Individual |
| Full Name | CARROLL D. BLACKLEDGE |
| Credential | MA, P-LPC |
| Practice Address |
4500 I 55 N Ste 208 Jackson MS 39211-5931 |
| Mailing Address |
107 Laurel Glen Ct Madison MS 39110-7395 |
| Practice Telephone | 6014057440 |
| Mailing Telephone | 6016227277 |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-02-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
P-0512 | MS | Behavioral Health & Social Service Providers |
| Street Address |
4500 I 55 N STE 208 |
| City | JACKSON |
| State | MS |
| Zip Code | 39211-5931 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376082719 | Tyler Stacy | Counselor | 4500 I 55 N Ste 208, Jackson, MS 39211-5931 | 2017-02-17 |
| 1023580651 | Morgan Henley Harris | Counselor | 4500 I 55 N Ste 208, Jackson, MS 39211-5931 | 2018-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760092878 | Bio-medical Applications of Mississippi, Inc. | Clinic/Center | 5722 I-55 N Frontage Road, Jackson, MS 39211 | 2020-08-04 |
| 1548881048 | Gloria Dansby-giles | Counselor | 4500 Interstate 55, North; Suite 220, Jackson, MS 39211 | 2020-05-06 |
| 1821628223 | Alice Powell Taylor | St. Dominic Weight Loss Solutions, 3800 Interstate 55 North Frontage Road Suite 102, Jackson, MS 39211 | 2020-01-24 | |
| 1356980643 | Bethany Powers | Pharmacist | 4910 Interstate 55 North Frontage Rd, Jackson, MS 39211 | 2020-01-03 |
| 1316585581 | Deborah Magoun Rosenbaum | Pharmacist | [email protected], 4910 I-55 North, Jackson, MS 39211 | 2019-12-18 |
| 1285108357 | Eric Wood | Counselor | 4623 Maurey Rd, Jackson, MS 39211 | 2019-01-11 |
| 1649758301 | Isluv Robertson | Registered Nurse | 1405 E Northside Dr, Jackson, MS 39211 | 2018-08-03 |
| 1659863066 | Jonbrighton Childs Russell | Student in an Organized Health Care Education/Training Program | 4343 Dalrymple Ct, Jackson, MS 39211 | 2018-05-31 |
| 1225557598 | Regina Ann Day | Dietitian, Registered | 3800 I 55 North Frontage Road, Jackson, MS 39211 | 2017-09-18 |
| 1023558525 | Agilitas Usa Inc | Clinic/Center | 120 District Blvd E, Suite D102, Jackson, MS 39211 | 2017-03-02 |
| Find all providers in zip 39211 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902411663 | Kristen Camille Kapler | Counselor | 3899 Division Rd, Jackson, WI 53037-9707 | 2020-09-10 |
| 1992339071 | Open Door Family Counseling | Counselor | 316 S Brown St Ste A, Jackson, MI 49203-1481 | 2020-02-27 |
| 1891334108 | Jamie Alane Merrill | Counselor | 1214 Greenwood Ave, Jackson, MI 49203-3037 | 2020-01-03 |
| 1285273078 | Hall Consulting Services LLC | Counselor | 1155 Briarwood Dr, Jackson, MS 39211-4204 | 2019-12-27 |
| 1114496387 | New Direction Counseling Center, LLC | Counselor | 1200 N West Ave Ste 809, Jackson, MI 49202-2196 | 2018-11-17 |
| 1811490964 | Lifeworks Resources, LLC | Counselor | 575 S Royal St Ste 24, Jackson, TN 38301-7307 | 2018-03-15 |
| 1912409764 | Impact Behavioral Counseling LLC | Counselor | 1551 E County Line Rd Ste B, Jackson, MS 39211-1801 | 2018-03-07 |
| 1831697317 | Denise June Johnson | Counselor | 906 Lincoln St, Jackson, MI 49202-3251 | 2018-01-30 |
| 1033626031 | Heather R. Chruch | Counselor | 180 W Michigan Ave Ste 204, Jackson, MI 49201-1342 | 2017-12-29 |
| 1861908337 | Matthew T Tompkins | Counselor | 810 E Jackson Blvd Ste B1, Jackson, MO 63755-2400 | 2017-12-20 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.