Organization
LIFESOURCE OF NORTH CAROLINA
Active
Parent organization
LIFESOURCE OF NORTH CAROLINA
Other names
LifeSource of Alabama
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFESOURCE OF NORTH CAROLINA
Authorized official
PEGGY BADDOUR (PRESIDENT/OWNER)
(910) 777-9165
Entity
Organization
Contact information
Practice address
1424 MONTCLAIR RD, IRONDALE, AL 35210-2208
(910) 742-9243
Mailing address
PO BOX 538622, ATLANTA, GA 30353-8622
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/21/2017
Last updated
03/26/2021
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