| Lifesource Of North Carolina | |
|
939 Springdale Dr Clinton SC 29325-7266 | |
| (910) 742-9243 | |
| Not Available |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | General Practice |
| Location | 939 Springdale Dr, Clinton, South Carolina |
| Authorized Official Name and Position | Peggy L Baddour (PRESIDENT/OWNER) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 742-9243 | Lifesource Of North Carolina 939 Springdale Dr Clinton SC 29325-7266 Ph: (910) 742-9243 |
| NPI Number | 1972861789 |
|---|---|
| Provider Enumeration Date | 04/30/2012 |
| Last Update Date | 05/17/2022 |
| Certification Date | 05/17/2022 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20120801000901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972861789 | NPI | - | NPPES |
| GP5917 | Medicaid | SC |
| Provider Name | Valdon Walker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790913325 PECOS PAC ID: 3678562576 Enrollment ID: I20040506001601 |
| Provider Name | Brandy K Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578532040 PECOS PAC ID: 2062465362 Enrollment ID: I20050228000138 |
| Provider Name | Adrian Novit |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215062823 PECOS PAC ID: 7719063692 Enrollment ID: I20080319000120 |
| Provider Name | Eunice K Lehmacher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508099748 PECOS PAC ID: 6709924467 Enrollment ID: I20091117000670 |
| Provider Name | Alvin F Watson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710181672 PECOS PAC ID: 1850571787 Enrollment ID: I20110210000351 |
| Provider Name | Monica M Denoux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003259235 PECOS PAC ID: 7012157456 Enrollment ID: I20130709000419 |
| Provider Name | Kellie C Jurgonski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851732671 PECOS PAC ID: 9234373937 Enrollment ID: I20130919000445 |
| Provider Name | Ishan Bhansaly |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1972824357 PECOS PAC ID: 6507004157 Enrollment ID: I20131003000071 |
| Provider Name | Karen J Fulwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164414520 PECOS PAC ID: 6608923578 Enrollment ID: I20141124000655 |
| Provider Name | April M Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508005455 PECOS PAC ID: 4688992787 Enrollment ID: I20150422001066 |
| Provider Name | Linda Cappiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174633457 PECOS PAC ID: 6901815836 Enrollment ID: I20160205000714 |
| Provider Name | Mimi E Crawley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639601594 PECOS PAC ID: 9234409152 Enrollment ID: I20170810002895 |
| Provider Name | Louis Joseph Gallagher |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851303861 PECOS PAC ID: 9436157179 Enrollment ID: I20171113000356 |
| Provider Name | Deborah F Coleman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093787939 PECOS PAC ID: 4587923024 Enrollment ID: I20180109001269 |
| Provider Name | Michael Anthony Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568950426 PECOS PAC ID: 3577818780 Enrollment ID: I20180612001071 |
| Provider Name | Kimberly Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598912784 PECOS PAC ID: 8224326442 Enrollment ID: I20181204001474 |
| Provider Name | Stacey Lynn Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093226789 PECOS PAC ID: 2567720592 Enrollment ID: I20190312002652 |
| Provider Name | Vivian Breslin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356434955 PECOS PAC ID: 8022040732 Enrollment ID: I20190722002147 |
| Provider Name | Paige Marenah |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942650791 PECOS PAC ID: 6608114574 Enrollment ID: I20190925003959 |
| Provider Name | Melanie Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992348395 PECOS PAC ID: 1254766223 Enrollment ID: I20200121002617 |
| Provider Name | Dorothy Nivens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003261074 PECOS PAC ID: 8820381890 Enrollment ID: I20210901001925 |
| Provider Name | Tracey S Brannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518535426 PECOS PAC ID: 5496152456 Enrollment ID: I20210920000282 |
| Provider Name | Chacey Bryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699228734 PECOS PAC ID: 9234425885 Enrollment ID: I20220404001270 |
| Provider Name | Maggie Whitt Mazurek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376968487 PECOS PAC ID: 2466675822 Enrollment ID: I20220419002986 |
| Provider Name | Megan Wolff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568114650 PECOS PAC ID: 2466831524 Enrollment ID: I20220620001738 |
| Provider Name | Eleanor Tedesco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700930914 PECOS PAC ID: 9638119308 Enrollment ID: I20220822001319 |
| Provider Name | Isaac Joseph Mcfadden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316165079 PECOS PAC ID: 3870647506 Enrollment ID: I20220927001855 |
| Provider Name | Catherine M Kearon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003396490 PECOS PAC ID: 6709256886 Enrollment ID: I20230106000099 |
| Provider Name | Rebecca Nicole Williford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316585185 PECOS PAC ID: 1153740972 Enrollment ID: I20230126000644 |
| Provider Name | Quintara Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205572260 PECOS PAC ID: 8123499191 Enrollment ID: I20230130002674 |
| Provider Name | Raul Rodriguez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841554912 PECOS PAC ID: 2567715162 Enrollment ID: I20230303000162 |
| Provider Name | Alexandra Marie Ingram |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679283113 PECOS PAC ID: 4880069020 Enrollment ID: I20230331001316 |
| Provider Name | Rebecca Lawrence |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144248360 PECOS PAC ID: 4880691476 Enrollment ID: I20230426002663 |
| Provider Name | Ian Nicholas Shaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356041065 PECOS PAC ID: 3072970433 Enrollment ID: I20230531001954 |
| Provider Name | Christian Diane Sitterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972202810 PECOS PAC ID: 4385002849 Enrollment ID: I20230615002568 |
| Provider Name | Tierra Shemon Izzard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386333714 PECOS PAC ID: 1153781216 Enrollment ID: I20230720002560 |
| Provider Name | Alexandria Chastain Turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851071039 PECOS PAC ID: 1052774791 Enrollment ID: I20230829002890 |
| Provider Name | Anacorita Ellisor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205257730 PECOS PAC ID: 3779832027 Enrollment ID: I20231215001185 |
| Provider Name | April Moses Bull |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1326201955 PECOS PAC ID: 7012368525 Enrollment ID: I20240109004005 |
| Provider Name | Trina Michelle Cornelison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396042180 PECOS PAC ID: 1658724760 Enrollment ID: I20240125000166 |
| Provider Name | Phyllis Kathleen Azzarito |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013687797 PECOS PAC ID: 4981048188 Enrollment ID: I20240215002236 |
| Provider Name | Angela Marie Rasheed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144840943 PECOS PAC ID: 5698180651 Enrollment ID: I20240301001829 |
| Provider Name | Sherald Wilkes-clement |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669131637 PECOS PAC ID: 7113362781 Enrollment ID: I20240305003101 |
South Carolina Ctc, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1035 Medical Ridge Rd, Clinton, SC 29325 Phone: 760-710-0968 | |
Family Assessment Counseling Center Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3148 Highway 308, Clinton, SC 29325 Phone: 864-833-4040 Fax: 864-833-9978 | |
Family Assessment Counseling Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 28631 Hwy. 76 East, Clinton, SC 29325 Phone: 864-833-4040 | |
Carolina Counseling Associates Of The Upstate Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Plaza Cir Ste C, Clinton, SC 29325 Phone: 864-399-4425 | |
Thornwell Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 302 S Broad St, Clinton, SC 29325 Phone: 864-938-2100 Fax: 864-938-2122 | |
Blueridge Psych Associates, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1035 Medical Ridge Road, Clinton, Clinton, SC 29325 Phone: 864-415-2981 Fax: 864-895-2996 | |
Stepping Forward Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 512 Professional Park Rd, Clinton, SC 29325 Phone: 864-367-0949 Fax: 866-448-9303 |