LIFESOURCE OF NORTH CAROLINA

BLOOMFIELD, CT
NPI1972131308
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 Date2020-03-31
Last Update Date2021-03-26
Business Address
LIFESOURCE OF NORTH CAROLINA
140 PARK AVE
BLOOMFIELD, CT 06002-3207
Phone number: 910-742-9243
Mailing Address
LIFESOURCE OF NORTH CAROLINA
PO BOX 538622
ATLANTA, GA 30353-8622
Phone number: 910-742-9243