Healthcare Provider Details

I. General information

NPI: 1891606547
Provider Name (Legal Business Name): DENITA LYNDE LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 NORTHERN AVE
ROCKFORD IL
61107-5309
US

IV. Provider business mailing address

8616 NORTHERN AVE
ROCKFORD IL
61107-5309
US

V. Phone/Fax

Practice location:
  • Phone: 815-399-9700
  • Fax: 815-394-1401
Mailing address:
  • Phone: 815-399-9700
  • Fax: 815-394-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18000014963
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: