Lifesource of North Carolina

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

LIFESOURCE OF NORTH CAROLINA

Practice address

4600 W Washington St
South Bend, IN 46619-2320

Phone

(910) 742-9243

Fax

(888) 746-1787

NPI assigned

Mar 18, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peggy Baddour

Title

President

Phone

(910) 777-9165

Specialties & licenses 4

Addresses

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Lifesource of North Carolina

  • Clinical Social Worker
  • Holland, OH
  • NPI 1619515277

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1295311595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 538622",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303538622",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 W WASHINGTON ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466192320",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESOURCE OF NORTH CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-18",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "BADDOUR",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-777-9165"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Jane Lies, MSN, RN
• Life Access Group LLC
• Life in Balance, LLC
• Life Solutions Inc (Stephanie Sarell)
• Life Treatment Centers
• Lifetime Dental Careof Indiana, PC (South Bend Family Dental Care)
• Tera Lighthall
• Teri Lighthall
• Maia Ligocki, RBT
• Lily Shroyer LCSW LLC

• Psychiatry Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.