Provider Demographics
NPI:1639294747
Name:LYTCH, CARROLL YVETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:YVETTE
Last Name:LYTCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 GLENLEA WALK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-9531
Mailing Address - Country:US
Mailing Address - Phone:704-393-5826
Mailing Address - Fax:
Practice Address - Street 1:5354 GLENLEA WALK LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-9531
Practice Address - Country:US
Practice Address - Phone:704-393-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2604103TC0700X
SC768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical