Lifesource of North Carolina
Lifesource of North Carolina is a Clinical Psychologist in Milwaukee, Wisconsin. Registered with an NPI since 2019.
- In the registry since
- 2019
- Specialties on file
- 5
Practice location Address checks out
3540 S 43rd StMilwaukee, WI 53220-1502
Phone: (910) 742-9243
Fax: (888) 746-1787
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Clinical Social Worker (primary) | Taxonomy 1041C0700X |
|---|---|
| Clinical Psychologist | Taxonomy 103TC0700X |
| Psychiatry Physician | Taxonomy 2084P0800X |
| Physician Assistant | Taxonomy 363A00000X |
| Nurse Practitioner | Taxonomy 363L00000X |
Record details
| NPI number | 1871135723 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Peggy Baddour — President/Owner · (910) 777-9165 |
| NPI enumerated | October 11, 2019 |
| Last updated in NPPES | March 26, 2021 |
| Certification date | March 26, 2021 |
| Mailing address | Po Box 538622, Atlanta, GA 30353-8622 |
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