Healthcare Provider Details

I. General information

NPI: 1336087261
Provider Name (Legal Business Name): MARY ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 N PARK DR
EAST SAINT LOUIS IL
62204-2037
US

IV. Provider business mailing address

5000 N PARK DR
EAST SAINT LOUIS IL
62204-2037
US

V. Phone/Fax

Practice location:
  • Phone: 618-979-0120
  • Fax:
Mailing address:
  • Phone: 618-979-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY HAMIEL
Title or Position: THERAPIST
Credential: SOCIAL WORKER
Phone: 314-623-0297