Provider Demographics
NPI:1043756224
Name:REIGNITE PSYCHOLOGICAL & CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:REIGNITE PSYCHOLOGICAL & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAYTRAYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-595-9003
Mailing Address - Street 1:2001 BENNING RD NE
Mailing Address - Street 2:FL 2
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4728
Mailing Address - Country:US
Mailing Address - Phone:202-595-9003
Mailing Address - Fax:202-595-9009
Practice Address - Street 1:2001 BENNING RD NE
Practice Address - Street 2:FL 2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4728
Practice Address - Country:US
Practice Address - Phone:202-595-9003
Practice Address - Fax:202-595-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001159103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty