LIFESOURCE OF NORTH CAROLINA

RICHMOND, VA
NPI1114419124
Entity TypeOrganization
Authorized ContactPEGGY BADDOUR
President/Owner
910-777-9165
Organization Subpart ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
Additional Taxonomies103TC0700X Psychologist, Clinical
2084P0800X Psychiatry & Neurology, Psychiatry
363A00000X Physician Assistant
363L00000X Nurse Practitioner
Enumeration Date2018-06-05
Last Update Date2021-03-25
Business Address
LIFESOURCE OF NORTH CAROLINA
1901 LIBBIE AVE
RICHMOND, VA 23226-1808
Phone number: 910-742-9243
Mailing Address
LIFESOURCE OF NORTH CAROLINA
PO BOX 538622
ATLANTA, GA 30353-8622
Phone number: 910-742-9243