MEDICARE: LOTUSPATH EMPOWERMENT THERAPY 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	:	1396558946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUSPATH EMPOWERMENT THERAPY PLLC

Provider Business Mailing Address
First Line	:	563 WHITLEY RIDGE DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-8645
Country	:	US
Telephone Number	:	757-759-0953
Fax Number	:

Provider Business Practice Location Address
First Line	:	563 WHITLEY RIDGE DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-8645
Country	:	US
Telephone Number	:	757-759-0953
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTEL DAWN BYRD
Credential	:	LCSW
Telephone Number	:	757-759-0953

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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