| 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 | Amy Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992340970 PECOS PAC ID: 5294620464 Enrollment ID: I20200128000009 |
| Provider Name | Aizhan Tyndybekova Repchak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992070379 PECOS PAC ID: 0446687867 Enrollment ID: I20200225001757 |
| Provider Name | James Gilder Bouknight |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174584916 PECOS PAC ID: 3476525593 Enrollment ID: I20200624001552 |
| 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 |
Broad Rock Counseling And Training Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2545 Bellwood Road, Suite 112, Richmond, VA 23237 Phone: 804-275-9980 Fax: 804-275-9981 | |
Pbs Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3018 W Clay St, Suite 204, Richmond, VA 23230 Phone: 804-447-4629 Fax: 804-447-4629 | |
Capstone Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1803 N 28th St, Richmond, VA 23223 Phone: 804-525-5386 Fax: 804-442-7069 | |
Rowe Counseling Services, Llc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 116 Brandon Rd Suite 117, Richmond, VA 23224 Phone: 804-677-1733 Fax: 804-230-1723 | |
Watchtower Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 800 Semmes Ave Apt 613, Richmond, VA 23224 Phone: 804-929-8229 | |
You Matter Residential Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 S 5th St, Richmond, VA 23219 Phone: 804-447-6590 Fax: 804-447-3516 | |
New Living Serivices Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1806 Summit Ave Ste 300, Richmond, VA 23230 Phone: 804-358-9679 |