1. Home
  2. Directory
  3. California
  4. Campo
  5. Peer Specialist
  6. NPI Profile

CHARLES JOHNSON ETHELBAH CMPSS
NPI 1447125885
Peer Specialist in Campo, CA

Active since October 07, 2025
1777 BUCKMAN SPRINGS RD, CAMPO, CA 91906(619) 478-5696 Get Directions Write a Review

NPPES record last updated: October 7, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Charles Johnson Ethelbah Cmpss NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLES JOHNSON ETHELBAH CMPSS (NPI 1447125885) is an individual peer specialist in Campo, California, licensed in California (MPSS-ZKDUCT) and active in the NPI registry since October 2025.

NPPES Registry Identity

NPI1447125885
Entity TypeIndividualMale
Primary Taxonomy175T00000X
Provider Legal NameCHARLES JOHNSON ETHELBAHCredential: CMPSS
Location Address1777 BUCKMAN SPRINGS RDCampo, CA 91906-2022
Mailing Address1777 Buckman Springs RdCampo, CA 91906-2022 · (619) 478-5696
Phone(619) 478-5696
Sole ProprietorNo
Enumeration DateOctober 7, 2025
NPPES CertifiedOctober 7, 2025
✔ NPI 1447125885 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in CA · MPSS-ZKDUCT
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
1777 BUCKMAN SPRINGS RD, Campo, CA 91906
Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OMAR HERNANDEZ RADT
Counselor (Addiction (Substance Use Disorder))
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696
JONATHAN SANDOVAL CCMA
Physician Assistant
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696
MR. MARCO MARTINEZ RADT
Counselor (Addiction (Substance Use Disorder))
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696
CORINNA D. BYNUM RN
Registered Nurse (Administrator)
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696
TIM SHAPLIN RADT
Counselor (Addiction (Substance Use Disorder))
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696
SAN DIEGO FREEDOM RANCH, INC.
Substance Abuse Rehabilitation Facility
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696
CARLOS ALBERTO RAMIREZ RADT
Counselor (Addiction (Substance Use Disorder))
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696
CHRISTOPHER DAVID SERNA CPSS
Counselor (Addiction (Substance Use Disorder))
1777 BUCKMAN SPRINGS RD
CAMPO, CA 91906
San Diego County (619) 478-5696

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Ethelbah's NPI number?

The NPI number for Charles Ethelbah is 1447125885. It was assigned to this individual provider in the NPPES registry on October 7, 2025.

Where is Charles Ethelbah located?

Charles Ethelbah practices at 1777 Buckman Springs Rd, Campo, CA 91906. The listed phone number is (619) 478-5696.

What is Charles Ethelbah's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Charles Ethelbah was last updated on October 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.