| 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 | William M Anderson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831148667 PECOS PAC ID: 7012816085 Enrollment ID: I20040108000290 |
| Provider Name | Brandy K Kennedy |
|---|---|
| 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 | 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 | Ishan Bhansaly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972824357 PECOS PAC ID: 6507004157 Enrollment ID: I20131003000071 |
| Provider Name | Tara-marie Devlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679907059 PECOS PAC ID: 0042446965 Enrollment ID: I20131126000085 |
| Provider Name | July Romely Damour |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1851470215 PECOS PAC ID: 2567656457 Enrollment ID: I20140703002176 |
| Provider Name | Peter L Zervos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619111804 PECOS PAC ID: 0446415194 Enrollment ID: I20141113001813 |
| 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 | Kimberly B Trammell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144603648 PECOS PAC ID: 3072826643 Enrollment ID: I20150727000139 |
| Provider Name | Linda Cappiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174633457 PECOS PAC ID: 6901815836 Enrollment ID: I20160205000714 |
| Provider Name | La'quandra Rampersant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336519776 PECOS PAC ID: 0941582829 Enrollment ID: I20170130001445 |
| 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 | Elizabeth Ann Hinz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699181230 PECOS PAC ID: 2860750304 Enrollment ID: I20171211002089 |
| Provider Name | Deborah F Coleman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093787939 PECOS PAC ID: 4587923024 Enrollment ID: I20180109001269 |
| Provider Name | Lisa Mcarthur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659875565 PECOS PAC ID: 2163787193 Enrollment ID: I20180523000055 |
| Provider Name | Michael Anthony Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568950426 PECOS PAC ID: 3577818780 Enrollment ID: I20180612001071 |
| Provider Name | Janette S Shelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699257196 PECOS PAC ID: 0143574368 Enrollment ID: I20181106003259 |
| Provider Name | Kimberly Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598912784 PECOS PAC ID: 8224326442 Enrollment ID: I20181204001474 |
| Provider Name | Elizabeth a Kurth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881942829 PECOS PAC ID: 1052621596 Enrollment ID: I20190213000056 |
| Provider Name | Glenda Pulliam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952871055 PECOS PAC ID: 4082882139 Enrollment ID: I20190215002278 |
| Provider Name | Edna Obehi Idehen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780170571 PECOS PAC ID: 7416200779 Enrollment ID: I20190522001844 |
| 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 | Tasha Lavon Hinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639443344 PECOS PAC ID: 0749529303 Enrollment ID: I20210316000303 |
| Provider Name | Chacey Bryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699228734 PECOS PAC ID: 9234425885 Enrollment ID: I20220404001270 |
| Provider Name | Adrianna Deise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689916629 PECOS PAC ID: 9638558877 Enrollment ID: I20220709000408 |
| Provider Name | Raul Rodriguez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841554912 PECOS PAC ID: 2567715162 Enrollment ID: I20230303000162 |
| Provider Name | Ian Nicholas Shaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356041065 PECOS PAC ID: 3072970433 Enrollment ID: I20230531001954 |
| Provider Name | Tiffany Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417648916 PECOS PAC ID: 4688033350 Enrollment ID: I20230629000732 |
| Provider Name | Deborah Sadek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790487577 PECOS PAC ID: 5193173342 Enrollment ID: I20231128002799 |
| 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 | Erin Pruitt Drennon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821855602 PECOS PAC ID: 3870930993 Enrollment ID: I20240326000488 |
| Provider Name | Ma Melissa Reyes Sarmiento |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740036938 PECOS PAC ID: 6406392380 Enrollment ID: I20240726003979 |
| Provider Name | Ronne Justine Proch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427437987 PECOS PAC ID: 7517265218 Enrollment ID: I20240812003270 |
| Provider Name | Ivra Yvette Pace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326378993 PECOS PAC ID: 2163963257 Enrollment ID: I20240917000266 |
| Provider Name | Denita Waltower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720750847 PECOS PAC ID: 7012446586 Enrollment ID: I20250129000004 |
| Provider Name | Laurrinda H Saxon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538405063 PECOS PAC ID: 8820528698 Enrollment ID: I20250207003047 |
| Provider Name | Cory Anthony Russell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720498785 PECOS PAC ID: 9739607730 Enrollment ID: I20250514000149 |
| Provider Name | Candace Dawn Cathcart |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1134793466 PECOS PAC ID: 6608389846 Enrollment ID: I20250701000505 |
| Provider Name | Maher Elharake |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598296956 PECOS PAC ID: 4284024860 Enrollment ID: I20250826004166 |
| Provider Name | Kenasia Meyon Glover |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588464481 PECOS PAC ID: 7911407598 Enrollment ID: I20250827000138 |
| Provider Name | Rachel Burlingame |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932820669 PECOS PAC ID: 1052803293 Enrollment ID: I20251125000658 |
| Provider Name | Paulette Beverly Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598099681 PECOS PAC ID: 3971095084 Enrollment ID: I20251125004500 |
| Provider Name | Lorena Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568051761 PECOS PAC ID: 1557806593 Enrollment ID: I20251216000591 |
| Provider Name | Robbilynn H Irby |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740151232 PECOS PAC ID: 9234625039 Enrollment ID: I20251231002269 |
| Provider Name | Audrey Sawyer Godfrey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609572981 PECOS PAC ID: 5890271142 Enrollment ID: I20260107002078 |
Clinton Comprehensive Treatment Center 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 |