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Contact Information

LIFESOURCE OF NORTH CAROLINA
4600 W WASHINGTON ST
SOUTH BEND, IN46619-2320
 Phone: 910-742-9243
 Fax: 888-746-1787
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for LIFESOURCE OF NORTH CAROLINA · (Female)

NPI Number 1295311595
Status Active
Credentials
Entity Individual
Enumeration date 03/18/2021
Last updated 03/18/2021 - About 5 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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