LIFESOURCE OF NORTH CAROLINA

MILTON, FL
NPI1730648288
Entity TypeOrganization
Authorized ContactPEGGY BADDOUR
President
910-777-9165
Organization Subpart ?No
Primary Taxonomy103T00000X Psychologist
Additional Taxonomies363LP0808X Nurse Practitioner, Psych/Mental Health
1041C0700X Social Worker, Clinical
2084P0800X Psychiatry & Neurology, Psychiatry
363A00000X Physician Assistant
363L00000X Nurse Practitioner
Enumeration Date2019-03-14
Last Update Date2021-03-25
Business Address
LIFESOURCE OF NORTH CAROLINA
5530 NORTHROP RD
MILTON, FL 32570-8701
Phone number: 910-742-9243
Mailing Address
LIFESOURCE OF NORTH CAROLINA
PO BOX 538622
ATLANTA, GA 30353-8622
Phone number: 910-794-4521