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NPI Profile for LIFESOURCE OF NORTH CAROLINA in CLINTON, SC.
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
General Practice |
208D00000X | 99 | Physician/Undefined Physician type[6] | |
Clinical |
103TC0700X | 62 | Psychologist, Clinical | |
Clinical |
1041C0700X | 80 | Licensed Clinical Social Worker | |
Family Medicine |
207Q00000X | 08 | Physician/Family Practice | |
Nurse Practitioner |
363L00000X | 50 | Nurse Practitioner | |
Physician Assistant |
363A00000X | 97 | Physician Assistant | |
Psychiatry |
2084P0800X | 26 | Physician/Psychiatry |
| NPI # | 1972861789 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 04/30/2012 | |
| Last updated | 05/17/2022 - About 4 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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LIFESOURCE OF NORTH CAROLINA
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LIFESOURCE OF NORTH CAROLINA