Healthcare Provider Details

I. General information

NPI: 1558526079
Provider Name (Legal Business Name): ERIN DEGOSTIN LYTLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CORPORATE HILL DR STE 330
LITTLE ROCK AR
72205-4528
US

IV. Provider business mailing address

10 CORPORATE HILL DR STE 330
LITTLE ROCK AR
72205-4528
US

V. Phone/Fax

Practice location:
  • Phone: 501-954-7470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6533C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: