Healthcare Provider Details

I. General information

NPI: 1639294747
Provider Name (Legal Business Name): CARROLL YVETTE LYTCH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 GLENLEA WALK LN
CHARLOTTE NC
28216-9531
US

IV. Provider business mailing address

5354 GLENLEA WALK LN
CHARLOTTE NC
28216-9531
US

V. Phone/Fax

Practice location:
  • Phone: 704-393-5826
  • Fax:
Mailing address:
  • Phone: 704-393-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2604
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number768
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: