Charles Johnson Ethelbah, CMPSS Valid NPI
Individual provider · Peer Specialist · Campo, CA
- NPI
- 1447125885
- Type
- Individual (Type 1)
- Primary specialty
- Peer Specialist
- Specialty group
- Other Service Providers
- Taxonomy code
- 175T00000X
- License number
- MPSS-ZKDUCT (CA)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2025-10-07
- Last updated
- 2025-10-07
Practice location
1777 Buckman Springs Rd
Campo, CA 91906-2022
(619) 478-5696