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Contact Information

LIFESOURCE OF NORTH CAROLINA
3540 S 43RD ST
MILWAUKEE, WI53220-1502
 Phone: 910-742-9243
 Fax: 888-746-1787
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

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 Number 1871135723
LBN Legal business name LIFESOURCE OF NORTH CAROLINA
Authorized official PEGGY BADDOUR - (PRESIDENT/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/11/2019
Last updated 03/26/2021 - About 5 years ago
Identifiers n/a
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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