LIFESOURCE OF NORTH CAROLINA

SLIDELL, LA
NPI1497378848
Entity TypeOrganization
Authorized ContactPEGGY L BADDOUR
President
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
364S00000X Clinical Nurse Specialist
Enumeration Date2020-05-20
Last Update Date2021-03-25
Business Address
LIFESOURCE OF NORTH CAROLINA
505 ROBERT BLVD
SLIDELL, LA 70458-1645
Phone number: 910-742-9243
Mailing Address
LIFESOURCE OF NORTH CAROLINA
PO BOX 538622
ATLANTA, GA 30353-8622
Phone number: 910-535-1211