Healthcare Provider Details

I. General information

NPI: 1972032167
Provider Name (Legal Business Name): NICHOLLAS RAYFIELD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-5813
US

IV. Provider business mailing address

145 CENTURY DR APT 5209
ALEXANDRIA VA
22304-5790
US

V. Phone/Fax

Practice location:
  • Phone: 202-525-4844
  • Fax:
Mailing address:
  • Phone: 504-909-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: