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General NPI Number Information
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NPI Number | 1639415219
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Entity Type | Individual
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Provider Name | LAYTRAYAL ANTIONETTE SIMMONS LPC, PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2012
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 2407 BENNING RD NE FL 2
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City | WASHINGTON
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State | DC
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Zip | 20002-4800
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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 | 2407 BENNING RD NE
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City | WASHINGTON
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State | DC
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Zip | 20002-4800
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY1001159
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC14145
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License Number State | DC
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Taxonomy #3
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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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