LIFESOURCE OF NORTH CAROLINA

HOPKINS, MN
NPI1801431127
Entity TypeOrganization
Authorized ContactPEGGY 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
Enumeration Date2019-11-11
Last Update Date2021-03-26
Business Address
LIFESOURCE OF NORTH CAROLINA
725 2ND AVE S
HOPKINS, MN 55343-7782
Phone number: 910-742-9243
Mailing Address
LIFESOURCE OF NORTH CAROLINA
PO BOX 538622
ATLANTA, GA 30353-8622
Phone number: 910-742-9243