LIFESOURCE OF NORTH CAROLINA (NPI# 1114419124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114419124 |
| Entity Type | Organization |
| Organization Name | LIFESOURCE OF NORTH CAROLINA |
| Practice Address |
1901 Libbie Ave Richmond VA 23226-1808 |
| Mailing Address |
Po Box 538622 Atlanta GA 30353-8622 |
| Practice Telephone | 9107429243 |
| Practice Fax Number | 8887461787 |
| Mailing Telephone | 9107429243 |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-09-21 |
| 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 | 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 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10307 W Broad St., #309, Glen Allen, VA 230606716 | 9107429243 |
| 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 |
1901 LIBBIE AVE |
| City | RICHMOND |
| State | VA |
| Zip Code | 23226-1808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811334980 | Carmen Wong | Physical Medicine & Rehabilitation | 1901 Libbie Ave, Richmond, VA 23226 | 2013-05-30 |
| 1992340970 | Amy B Mitchell | Social Worker | 1901 Libbie Ave, Richmond, VA 23226-1808 | 2019-11-13 |
| 1073154373 | Glenburnie Operator LLC | Skilled Nursing Facility | 1901 Libbie Ave, Richmond, VA 23226-1808 | 2019-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033625744 | Eye Surgeons of Richmond, Inc. | Eyewear Supplier (Equipment, not the service) | 5875 Bremo Rd Ste 606, Richmond, VA 23226 | 2017-12-18 |
| 1922517028 | Karen Margaret Karwowski | Physical Therapist | 1901 Charles Street, Crestview Elementary School, Henrico, VA 23226 | 2017-09-21 |
| 1831636463 | Tammy A Lewis | Nurse Practitioner | 5803 Bremo Road, Richmond, VA 23226 | 2017-01-20 |
| 1497116438 | Ashton Williams | Counselor | 2008 Libbie Avenue, Suite 101, Richmond, VA 23226 | 2016-03-18 |
| 1396110078 | Nino Carlo Deleon | Dentist | 5500 Monument Ave Ste G, Richmond, VA 23226 | 2015-12-07 |
| 1083097794 | Amy Michelle Kruger | Podiatrist | 2008 Bremo Rd Ste 100, Richmond, VA 23226 | 2015-06-30 |
| 1841682762 | James Bryce Lothian | Pediatrics | 5875 Bremo Road, Mob South, Suite 303, Pediatric Lung Care, Richmond, VA 23226 | 2015-03-02 |
| 1841533890 | Lauren Etz Freeman | Nurse Practitioner | 7113 Three Chopt Road, Suite 101, Pediatric Associates of Richmond, Inc., Richmond, VA 23226 | 2013-03-28 |
| 1609126044 | Tammy Denise Mills | Nurse Practitioner | 1501 Maple Ave Ste 301, Richmond, VA 23226 | 2012-09-13 |
| 1083987937 | Christopher Ronald Richardson | Dentist | 4909 Grove Avenue, Richmond, VA 23226 | 2012-02-22 |
| Find all providers in zip 23226 | ||||
| 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 |
|---|---|---|---|---|
| 1932709714 | Jennifer Lynn Sistrunk | Social Worker | 5608 Riverside Heights Way, Richmond, VA 23225-2478 | 2020-10-29 |
| 1023618311 | John Francis Feeney | Social Worker | 1108 E Main St Ste 900, Richmond, VA 23219-3522 | 2020-10-27 |
| 1891394839 | Amanda Firestone LLC | Social Worker | 2804 Griffin Ave, Richmond, VA 23222-3629 | 2020-10-21 |
| 1306443312 | Higgins Center for Healing, LLC | Social Worker | 3311 W Broad St # 212, Richmond, VA 23230-5000 | 2020-10-02 |
| 1902410400 | Libby Tofflemire | Social Worker | 601 Boroughbridge Rd, Richmond, VA 23225-6218 | 2020-09-02 |
| 1275146235 | Chelsea Barbara Hooker | Social Worker | 444 Kingstown Rd, Richmond, RI 02892-1105 | 2020-08-28 |
| 1649883232 | Silka Graciela Steele | Social Worker | 700 Everett St Apt 2135, Richmond, VA 23224-0015 | 2020-08-25 |
| 1588275770 | Melani Jones | Social Worker | 10825 Midlothian Turnpike Ste 201r, Richmond, VA 23235 | 2020-08-12 |
| 1427668706 | Samantha Joan Coppola | Social Worker | 3220 Brook Rd Apt 203, Richmond, VA 23227-4850 | 2020-08-03 |
| 1053921395 | Rachelle Lee Butler | Social Worker | 2820 E Broad St Apt A, Richmond, VA 23223-7342 | 2020-08-02 |
| Find all providers in RICHMOND | ||||
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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.