Organization · Type 2 NPI

Lifesource of North Carolina

Clinical Social Worker · Richmond, VA

NPI number 1114419124 Active

Practice location

1901 Libbie Ave
Richmond, VA 23226-1808

Call (910) 742-9243 Map

Fax (888) 746-1787

Mailing address

PO Box 538622
Atlanta, GA 30353-8622

Other practice locations

  • 10307 W Broad St., #309, Glen Allen, VA 23060-6716 · (910) 742-9243

Specialties and licenses

TaxonomyCodeLicense
Clinical Psychologist 103TC0700XNone listed
Clinical Social Worker Primary 1041C0700XNone listed
Psychiatry Physician 2084P0800XNone listed
Physician Assistant 363A00000XNone listed
Nurse Practitioner 363L00000XNone listed

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

8 other providers at this address

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About NPI 1114419124

Lifesource of North Carolina's National Provider Identifier is 1114419124, issued on Jun 5, 2018. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Richmond, VA. The record was last updated on Mar 25, 2021.