Provider Demographics
NPI:1063928299
Name:PRESLAR, CARLEY (MSW)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:PRESLAR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 TOWNE CENTER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4837
Mailing Address - Country:US
Mailing Address - Phone:601-952-0894
Mailing Address - Fax:601-952-0836
Practice Address - Street 1:357 TOWNE CENTER PL STE 100
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4837
Practice Address - Country:US
Practice Address - Phone:601-952-0894
Practice Address - Fax:601-952-0836
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty