Active NPI
Carroll D. Blackledge, MA, P-LPC
- Professional Counselor
- Jackson, MS
National Provider Identifier
1295292274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P-0512
- Practice address
- 4500 I 55 N Ste 208
Jackson, MS 39211-5931 - Phone
- (601) 405-7440
- NPI assigned
- Feb 26, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | P-0512 | MS | Primary |
Addresses
Primary practice location
4500 I 55 N Ste 208
Jackson, MS 39211-5931
Mailing address
107 Laurel Glen CT
Madison, MS 39110-7395
Phone (601) 622-7277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 8, 2024 through Jul 8, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P-0512 | MS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551139200000",
"number": "1295292274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 LAUREL GLEN CT",
"city": "MADISON",
"state": "MS",
"postal_code": "391107395",
"telephone_number": "601-622-7277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 I 55 N STE 208",
"city": "JACKSON",
"state": "MS",
"postal_code": "392115931",
"telephone_number": "601-405-7440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKLEDGE",
"first_name": "CARROLL",
"middle_name": "D.",
"credential": "MA, P-LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-26",
"last_updated": "2019-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MS",
"license": "P-0512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.