LIFESOURCE OF NORTH CAROLINA (NPI# 1386144418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386144418 |
| Entity Type | Organization |
| Organization Name | LIFESOURCE OF NORTH CAROLINA |
| Practice Address |
1208 E Pershing Blvd Cheyenne WY 82001-3230 |
| Mailing Address |
Po Box 538622 Atlanta GA 30353-8622 |
| Practice Telephone | 9107429243 |
| Practice Fax Number | 8887461787 |
| Mailing Telephone | 9107429243 |
| Mailing Fax Number | 8887461787 |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2018-02-15 |
| Authorized Official Name | PEGGY BADDOUR (PRESIDENT/OWNER) |
| Authorized Official Telephone | 9103955569 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497378848 | Lifesource of North Carolina | Psychologist | 8315 Zimpel St, New Orleans, LA 70118-1169 | 2020-05-20 |
| 1649877762 | Lifesource of North Carolina | Psychologist | 501 2nd St, Menominee, MI 49858-3203 | 2020-10-01 |
| 1972131308 | Lifesource of North Carolina | Psychologist | 140 Park Ave, Bloomfield, CT 06002-3207 | 2020-03-31 |
| 1619515277 | Lifesource of North Carolina | Psychologist | 204 W Main St, New London, OH 44851-1070 | 2019-12-13 |
| 1801431127 | Lifesource of North Carolina | Psychologist | 725 2nd Ave S, Hopkins, MN 55343-7782 | 2019-11-11 |
| 1174168496 | Lifesource of North Carolina | Psychologist | 600 Main St S, Minot, ND 58701-4499 | 2019-11-11 |
| 1801431440 | Lifesource of North Carolina | Psychologist | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2019-11-07 |
| 1093350647 | Lifesource of North Carolina | Psychologist | 2900 W E St, North Platte, NE 69101-1803 | 2019-11-07 |
| 1871135723 | Lifesource of North Carolina | Psychologist | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2019-10-11 |
| 1538728183 | Lifesource of North Carolina | Psychologist | 200 Nursing Home Ln, Pikeville, KY 41501-6896 | 2019-06-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | LifeSource of North Carolina Inc. | 5617 Maxwell Place, Wilmington, North Carolina 28408 |
| Alabama Business Registrations | LifeSource of North Carolina, Inc. | 5617 Maxwell Place, Wilmington, NC 28409 |
| Street Address |
1208 E PERSHING BLVD |
| City | CHEYENNE |
| State | WY |
| Zip Code | 82001-3230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760502009 | Choice Counseling | Counselor | 1208 E Pershing Blvd, Cheyenne, WY 82001-3230 | 2007-03-30 |
| 1881145886 | Serenity Mental Health Billing | Marriage & Family Therapist | 1208 E Pershing Blvd, Cheyenne, WY 82001-3230 | 2016-10-14 |
| 1255792883 | Ascension Health Network, LLC | Clinic/Center | 1208 E Pershing Blvd, Cheyenne, WY 82001-3230 | 2016-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194382150 | Brain Advancement Center, LLC | Counselor | 2005 Warren Ave., Cheyenne, WY 82001 | 2019-05-24 |
| 1255897385 | Humble Horizon Home Health LLC | Case Management | 6066 Wilderness Trl, Cheyenne, WY 82001 | 2019-02-13 |
| 1396214722 | Megan Kraushaar | Behavior Technician | 3120 Old Faithful Rd, Cheyenne, WY 82001 | 2018-11-14 |
| 1255815536 | Michelle Mae Mccoy | Social Worker | 2360 E Perishing Blvd, Cheyenne, WY 82001 | 2018-09-21 |
| 1750869616 | Finding Peace Counseling, LLC | Counselor | 1603 Capitol Ave Ste 510b, Cheyenne, WY 82001 | 2018-08-02 |
| 1457855595 | Better Life Counseling LLC | Counselor | 2909 Bent Ave Ste 5, Cheyenne, WY 82001 | 2018-03-22 |
| 1942729066 | Brittany Heinzman | Community Health Worker | 2000 Westland Road Suite C, Cheyenne, WY 82001 | 2017-09-11 |
| 1144768086 | Cheyenne Regional Home Home Care Services | Case Management | 214 E 23rd Street, Cheyenne, WY 82001 | 2017-02-10 |
| 1104360726 | Jennifer Pannebaker | Behavioral Analyst | 813 Randall Ave, Cheyenne, WY 82001 | 2016-12-16 |
| 1053854703 | Raven Coward Long | Social Worker | 821 East Pershing Blvd, Cheyenne, WY 82001 | 2016-11-29 |
| Find all providers in zip 82001 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831670744 | Medical Associates | General Practice | 1616 E 19th St Ste 8, Cheyenne, WY 82001-4946 | 2018-08-28 |
| 1003836834 | Medi Horizons Inc | General Practice | 2030 Bluegrass Cir, Cheyenne, WY 82009-7328 | 2006-07-21 |
| 1508808239 | Digestive Health Associates of Cheyenne | General Practice | 7212 Commons Cir, Cheyenne, WY 82009-2667 | 2006-06-10 |
| 1245798511 | Northview Medical Clinic LLC | General Practice | 7356 Stockman St, Cheyenne, WY 82009-6006 | 2019-03-06 |
| 1962821074 | Sonja Langley | General Practice | 501 S Ll Males Ave, Cheyenne, OK 73628-0000 | 2014-04-16 |
| 1801153408 | Sandra A Guidry Md | General Practice | 214 E 23rd St, Cheyenne, WY 82001-3748 | 2012-04-19 |
| 1710263652 | Cornerstone Programs Corporation | General Practice | 3304 E I-80 Service Rd, Cheyenne, WY 82009-8781 | 2011-10-24 |
| 1073819207 | Clinical Decision Medical Services, LLC | General Practice | 1807 Capitol Ave, Suite 201, Cheyenne, WY 82001-4544 | 2011-02-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255974531 | Laura Elizabeth Boyd | General Practice | 4700 S Valley Rd, Casper, WY 82604-5149 | 2019-10-19 |
| 1114201845 | Cowboy Urgent Care, Inc | General Practice | 1453-a Dewar Drive, Rock Springs, WY 82901 | 2011-09-29 |
| 1932481355 | Willis Martin Franz | General Practice | 325 E. Warwick St., Newcastle, WY 82701-2253 | 2011-09-12 |
| 1457665333 | Teton County Hospital District | General Practice | Box 428 625 E Broadway Ave, Jackson, WY 83001-8642 | 2010-08-03 |
| 1538491899 | Peggy Knittel | General Practice | 171 Lupine Dr, Torrington, WY 82240-3504 | 2010-02-10 |
| 1033347885 | Frederick Joseph Araas | General Practice | 1428 W. 5th Street, Sheridan, WY 82801 | 2009-06-30 |
| 1598919177 | Stephen Chappelle Caughron | General Practice | One Grand Loop Rd., Yellowstone National Park, WY 82190 | 2008-11-10 |
| 1629121330 | Community Action Partnership of Natrona County | General Practice | 1514 E 12th St., Ste. 201, Casper, WY 82601 | 2007-01-18 |
| 1134297310 | Sandra Slade Mossbrook | General Practice | 8204 State Highway 789, Lander, WY 82520-2941 | 2006-12-04 |
| 1154491579 | Bruce Hayse | General Practice | 269 West Broadway, Jackson, WY 83001-1884 | 2006-11-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.