Healthcare Provider Details

I. General information

NPI: 1922560507
Provider Name (Legal Business Name): TRISTINA WILLIAMS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 BASELINE RD
LITTLE ROCK AR
72209-4728
US

IV. Provider business mailing address

6700 RIDGEMIST LN
NORTH LITTLE ROCK AR
72117-2294
US

V. Phone/Fax

Practice location:
  • Phone: 501-265-0302
  • Fax: 501-265-0300
Mailing address:
  • Phone: 501-631-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2508007
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: