Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178001961 | IL |
NPI | 1003483041 |
---|---|
Provider Name | Mrs. Denetra L Hardy |
First Address | Glenwood, IL 60425-1826 |
Second Address | Glenwood, IL 60425-1826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 12/07/2021 |