Healthcare Provider Details

I. General information

NPI: 1043756224
Provider Name (Legal Business Name): REIGNITE PSYCHOLOGICAL & CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BENNING RD NE FL 2
WASHINGTON DC
20002-4728
US

IV. Provider business mailing address

2001 BENNING RD NE FL 2
WASHINGTON DC
20002-4728
US

V. Phone/Fax

Practice location:
  • Phone: 202-595-9003
  • Fax: 202-595-9009
Mailing address:
  • Phone: 202-595-9003
  • Fax: 202-595-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY1001159
License Number StateDC

VIII. Authorized Official

Name: MS. LAYTRAYAL SIMMONS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 202-595-9003