Organization
LIFESOURCE OF NORTH CAROLINA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY BADDOUR (PRESIDENT)
(910) 777-9165
Entity
Organization
Contact information
Practice address
200 NURSING HOME LN, PIKEVILLE, KY 41501-6896
(910) 742-9243
(888) 746-1787
Mailing address
PO BOX 538622, ATLANTA, GA 30353-8622
(910) 535-1211
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
06/07/2019
Last updated
03/25/2021
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