| Lifesource Of North Carolina | |
|
1901 Libbie Ave Richmond VA 23226-1808 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Social Worker |
| Location | 1901 Libbie Ave, Richmond, Virginia |
| Authorized Official Name and Position | Peggy 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 1901 Libbie Ave Richmond VA 23226-1808 Ph: (910) 742-9243 |
| NPI Number | 1114419124 |
|---|---|
| Provider Enumeration Date | 06/05/2018 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20180806000818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114419124 | NPI | - | NPPES |
| Provider Name | Terrie L Pendleton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639262132 PECOS PAC ID: 8820990526 Enrollment ID: I20040123000032 |
| Provider Name | Linda Cappiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174633457 PECOS PAC ID: 6901815836 Enrollment ID: I20191211000409 |
| Provider Name | Erica Rochelle Alford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093238768 PECOS PAC ID: 4284986035 Enrollment ID: I20210416001591 |
| Provider Name | Isaac Joseph Mcfadden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316165079 PECOS PAC ID: 3870647506 Enrollment ID: I20240308002497 |
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