LIFESOURCE OF NORTH CAROLINA

MILWAUKEE, WI
NPI1871135723
Entity TypeOrganization
Authorized ContactPEGGY BADDOUR
President/Owner
910-777-9165
Organization Subpart ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
Additional Taxonomies2084P0800X Psychiatry & Neurology, Psychiatry
363A00000X Physician Assistant
363L00000X Nurse Practitioner
103TC0700X Psychologist, Clinical
Enumeration Date2019-10-11
Last Update Date2021-03-26
Business Address
LIFESOURCE OF NORTH CAROLINA
3540 S 43RD ST
MILWAUKEE, WI 53220-1502
Phone number: 910-742-9243
Mailing Address
LIFESOURCE OF NORTH CAROLINA
PO BOX 538622
ATLANTA, GA 30353-8622
Phone number: 910-742-9243