Individual
MARY GATES-GULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CADC
Contact information
Practice address
904 E. MARTIN LUTHER KING DRIVE, CENTRALIA, IL 62801
(618) 533-1391
(618) 533-0012
Mailing address
904 E. MARTIN LUTHER KING DRIVE, CENTRALIA, IL 62801
(618) 533-1391
(618) 533-0012
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21816
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370915481007
—
IL
Enumeration date
10/12/2007
Last updated
02/07/2018
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