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

Lifesource of North Carolina

Organization Clinical Psychologist · NPI 1972131308

Lifesource of North Carolina is a Clinical Psychologist in Bloomfield, Connecticut. Registered with an NPI since 2020.

In the registry since
2020
Specialties on file
5
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Practice location Address checks out

140 Park Ave
Bloomfield, CT 06002-3207
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 number1972131308
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Peggy Baddour — President · (910) 777-9165
NPI enumeratedMarch 31, 2020
Last updated in NPPESMarch 26, 2021
Certification dateMarch 26, 2021
Mailing addressPo Box 538622, Atlanta, GA 30353-8622

Other providers in Bloomfield