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Contact Information

LIFESOURCE OF NORTH CAROLINA
939 SPRINGDALE DR
CLINTON, SC29325-7266
 Phone: 910-742-9243
 Fax:
 Website:
 

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
Indicates primary specialty

NPI Profile & details for LIFESOURCE OF NORTH CAROLINA

NPI # 1972861789
LBN Legal business name LIFESOURCE OF NORTH CAROLINA
Authorized official PEGGY BADDOUR - (PRESIDENT/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/30/2012
Last updated 05/17/2022 - About 4 years ago
Identifiers
SC Medicaid GP5917
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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