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General NPI Number Information
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NPI Number | 1043756224
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Entity Type | Organization
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Legal Business Name | REIGNITE PSYCHOLOGICAL & CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 2001 BENNING RD NE FL 2
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City | WASHINGTON
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State | DC
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Zip | 20002-4728
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Country | US
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Telephone | 202-595-9003
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Fax | 202-595-9009
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Provider Business Mailing Address
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Address Line | 2001 BENNING RD NE FL 2
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City | WASHINGTON
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State | DC
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Zip | 20002-4728
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Country | US
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Telephone | 202-595-9003
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Fax | 202-595-9009
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MS. LAYTRAYAL SIMMONS
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Credential | PH.D.
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Telephone | 202-595-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY1001159
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License Number State | DC
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