Healthcare Provider Details

I. General information

NPI: 1700795044
Provider Name (Legal Business Name): CHANCE HAMILTON CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

406 E MAIN ST
BENTON IL
62812-2154
US

IV. Provider business mailing address

406 E MAIN ST
BENTON IL
62812-2154
US

V. Phone/Fax

Practice location:
  • Phone: 618-252-9036
  • Fax: 618-216-9993
Mailing address:
  • Phone: 618-252-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: