Lifesource of North Carolina
Lifesource of North Carolina is a Clinical Psychologist in Cheyenne, Wyoming. Registered with an NPI since 2018.
- In the registry since
- 2018
- Specialties on file
- 7
Practice location Address checks out
1208 E Pershing BlvdCheyenne, WY 82001-3230
Phone: (910) 742-9243
Fax: (888) 746-1787
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Specialties & licences
| General Practice Physician (primary) | Taxonomy 208D00000X |
|---|---|
| Clinical Psychologist | Taxonomy 103TC0700X |
| Clinical Social Worker | Taxonomy 1041C0700X |
| Family Medicine Physician | Taxonomy 207Q00000X |
| Psychiatry Physician | Taxonomy 2084P0800X |
| Physician Assistant | Taxonomy 363A00000X |
| Nurse Practitioner | Taxonomy 363L00000X |
Record details
| NPI number | 1386144418 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Peggy Baddour — President/Owner · (910) 777-9165 |
| NPI enumerated | February 15, 2018 |
| Last updated in NPPES | March 25, 2021 |
| Certification date | March 25, 2021 |
| Mailing address | Po Box 538622, Atlanta, GA 30353-8622 |
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Christine W Gray, PHD
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Christopher L Herron, PHD
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