Provider Demographics
NPI:1194918912
Name:LIVINGSTON, TINA JORDAN (LPC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:JORDAN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CLUB LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6191
Mailing Address - Country:US
Mailing Address - Phone:479-427-0096
Mailing Address - Fax:
Practice Address - Street 1:1312 DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3807
Practice Address - Country:US
Practice Address - Phone:501-450-6350
Practice Address - Fax:501-358-4932
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0705040101YM0800X
ARP1108051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health