Provider Demographics
NPI:1639415219
Name:SIMMONS, LAYTRAYAL ANTIONETTE (LPC, PHD)
Entity Type:Individual
Prefix:DR
First Name:LAYTRAYAL
Middle Name:ANTIONETTE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 BENNING RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4800
Mailing Address - Country:US
Mailing Address - Phone:202-595-9003
Mailing Address - Fax:202-595-9009
Practice Address - Street 1:2407 BENNING RD NE FL 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4800
Practice Address - Country:US
Practice Address - Phone:202-595-9003
Practice Address - Fax:202-595-9009
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-30
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001159103T00000X, 103TC1900X
DCPRC14145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional