Lifesource of North Carolina

NPI #1114419124 in Richmond, Virginia

Provider Information

NPI Number: 1114419124
Entity Type: Organization
Organization Name: Lifesource of North Carolina
Primary Specialty: Social Worker - Clinical
Enumeration Date: Jun 5, 2018
Last Updated: Mar 25, 2021

Practice Location

Address: 1901 LIBBIE AVE
City: Richmond
State: Virginia
ZIP Code: 23226-1808
Phone: (910) 742-9243

Authorized Official

Name: PEGGY BADDOUR
Title: PRESIDENT/OWNER
Phone: (910) 777-9165

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Social Worker - Clinical — Clinical	1041C0700X	Primary

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