Healthcare Provider Details

I. General information

NPI: 1154190791
Provider Name (Legal Business Name): TRINA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W ROOSEVELT RD
LOMBARD IL
60148-4402
US

IV. Provider business mailing address

1223 RUDOLPH ST APT 2B
CALUMET CITY IL
60409-5713
US

V. Phone/Fax

Practice location:
  • Phone: 708-543-6867
  • Fax:
Mailing address:
  • Phone: 708-543-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4678
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: