Healthcare Provider Details

I. General information

NPI: 1447170642
Provider Name (Legal Business Name): AMBER ELAINE LYTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 OLD GLORY RD UNIT 109
CLEMMONS NC
27012-9276
US

IV. Provider business mailing address

131 WOODLAND DR APT 307
ELKIN NC
28621-2471
US

V. Phone/Fax

Practice location:
  • Phone: 336-510-7910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: