LIFESOURCE OF NORTH CAROLINA (NPI# 1619515277) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619515277 |
| Entity Type | Organization |
| Organization Name | LIFESOURCE OF NORTH CAROLINA |
| Practice Address |
204 W Main St New London OH 44851-1070 |
| Mailing Address |
Po Box 538622 Atlanta GA 30353-8622 |
| Practice Telephone | 9107429243 |
| Practice Fax Number | 8887466178 |
| Mailing Telephone | 9105351211 |
| Mailing Fax Number | 9197467603 |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2019-12-13 |
| Authorized Official Name | PEGGY BADDOUR (PRESIDENT) |
| Authorized Official Telephone | 9105351211 |
| 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 | 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 | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| 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 |
| 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 |
| 1730648288 | Lifesource of North Carolina | Social Worker | 5530 Northrop Rd, Milton, FL 32570-8701 | 2019-03-14 |
| 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 |
204 W MAIN ST |
| City | NEW LONDON |
| State | OH |
| Zip Code | 44851-1070 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215143417 | Integrated Health Services of New London At Firelands | Nursing Facility/Intermediate Care Facility | 204 W Main St, New London, OH 44851-1070 | 2007-05-15 |
| 1457463556 | 204 W. Main Street Operating Company, LLC | Skilled Nursing Facility | 204 W Main St, New London, OH 44851-1070 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568029510 | Samaritan Regional Health System | Clinic/Center | 206 W Main St, New London, OH 44851 | 2019-05-24 |
| 1730567835 | Barbara Ann Trimmer | Licensed Practical Nurse | 19 Johnson Dr, New London, OH 44851-1010 | 2015-05-11 |
| 1669449351 | Jeffrey A Harwood | Family Medicine | 187 W Main St, New London, OH 44851-1018 | 2006-03-02 |
| 1356886618 | Haley Robuck | Nurse Practitioner | 187 W Main St, New London, OH 44851-1018 | 2016-12-22 |
| 1053756734 | The Laurels of New London, LLC | Skilled Nursing Facility | 201 W Main St, New London, OH 44851-1018 | 2013-05-08 |
| 1013969419 | New London Family Practice,llc | Family Medicine | 187 W Main St, New London, OH 44851-1018 | 2006-05-16 |
| 1568864759 | William Stewart | Home Health Aide | 142 Pearl St, New London, OH 44851-1023 | 2014-09-19 |
| 1174890891 | Brett Lynn Richards | Licensed Practical Nurse | 79 Birch Park Dr, New London, OH 44851-1103 | 2011-11-23 |
| 1114247715 | Kate A. Bradley | Registered Nurse | 81 White Ave, New London, OH 44851-1136 | 2010-06-04 |
| 1215560032 | Northern Ohio Medical Specialists, LLC | Durable Medical Equipment & Medical Supplies | 111 E Main St, New London, OH 44851-1201 | 2020-02-20 |
| Find all providers in zip 44851 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750856340 | Reed Therapy, LLC | Social Worker | 400 Bayonet St Ste 202, New London, CT 06320-2600 | 2018-10-10 |
| 1184124414 | Toni C Perry, Lcsw, LLC | Social Worker | 883 Montauk Ave Apt 2, New London, CT 06320-4238 | 2018-02-13 |
| 1033620679 | Elizabeth Allen | Social Worker | 106 Truman St, New London, CT 06320-5680 | 2017-10-23 |
| 1528502457 | Dianna Rodriguez | Social Worker | One Shaw's Cove, New London, CT 06320-6302 | 2016-12-12 |
| 1538612239 | Willow Creek Counseling LLC | Social Worker | 17 Ash Street, New London, MN 56273 | 2016-07-28 |
| 1477927739 | Chelsea Culbert | Social Worker | 464 Ocean Ave, New London, CT 06320-4544 | 2015-11-23 |
| 1912329962 | Janelle Posey-green | Social Worker | 302 State St., Suite 201, New London, CT 06320 | 2014-01-10 |
| 1750622692 | Cynthia Mitchell | Social Worker | 65b Michael Rd, New London, CT 06320 | 2013-03-01 |
| 1710219357 | Anne Marie Collins-reed | Social Worker | 315 River Road, New London, WI 54981 | 2010-02-08 |
| 1871827378 | December L Heffernan | Social Worker | 165 State St Ste 200, New London, CT 06320-6304 | 2009-09-30 |
| Find all providers in NEW LONDON | ||||
| City | NEW LONDON |
| Zip Code | 44851 |
Please comment or provide details below to improve the information on LIFESOURCE OF NORTH CAROLINA.
| 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.