Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lifesource of North Carolina

Organization Clinical Psychologist · NPI 1295311595

Lifesource of North Carolina is a Clinical Psychologist in South Bend, Indiana. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
4

Practice location Address checks out

4600 W Washington St
South Bend, IN 46619-2320
Phone: (910) 742-9243
Fax: (888) 746-1787
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X
Clinical Psychologist Taxonomy 103TC0700X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1295311595
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Peggy Baddour — President · (910) 777-9165
NPI enumeratedMarch 18, 2021
Last updated in NPPESMarch 18, 2021
Certification dateMarch 18, 2021
Mailing addressPo Box 538622, Atlanta, GA 30353-8622

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