MEDICARE: LILYPAD PATH, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1366384760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILYPAD PATH, PLLC

Provider Business Mailing Address
First Line	:	701 GREEN VALLEY RD STE 100
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7096
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 WOODLARK LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-4228
Country	:	US
Telephone Number	:	336-456-4909
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ANDREA JONES
Credential	:	LCSW
Telephone Number	:	336-456-4909

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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