Healthcare Provider Details

I. General information

NPI: 1396558946
Provider Name (Legal Business Name): LOTUSPATH EMPOWERMENT THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W HARGETT ST. SUITE 301
RALEIGH NC
27601
US

IV. Provider business mailing address

921 TOWN CENTRE BLVD # 508
CLAYTON NC
27520-2181
US

V. Phone/Fax

Practice location:
  • Phone: 757-759-0953
  • Fax:
Mailing address:
  • Phone: 757-759-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTEL DAWN BYRD
Title or Position: OWNER
Credential: LCSW
Phone: 984-223-0516