Lifesource of North Carolina

NPI #1730648288 in Milton, Florida

Provider Information

NPI Number: 1730648288
Entity Type: Organization
Organization Name: Lifesource of North Carolina
Primary Specialty: Psychologist
Enumeration Date: Mar 14, 2019
Last Updated: Mar 25, 2021

Practice Location

Address: 5530 NORTHROP RD
City: Milton
State: Florida
ZIP Code: 32570-8701
Phone: (910) 742-9243

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner - Psychiatric/Mental Health — Psychiatric/Mental Health	363LP0808X
Social Worker - Clinical — Clinical	1041C0700X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Psychologist	103T00000X	Primary

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