Provider Demographics
NPI:1003483041
Name:HARDY, DENETRA L (LPC)
Entity type:Individual
Prefix:MRS
First Name:DENETRA
Middle Name:L
Last Name:HARDY
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 1:302 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1826
Mailing Address - Country:US
Mailing Address - Phone:708-785-7810
Mailing Address - Fax:
Practice Address - Street 1:302 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1826
Practice Address - Country:US
Practice Address - Phone:708-785-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178001961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty