Healthcare Provider Details

I. General information

NPI: 1265323943
Provider Name (Legal Business Name): CHARLESTON BENTLEY ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E SHAW AVE STE 350
FRESNO CA
93710-7904
US

IV. Provider business mailing address

1322 E SHAW AVE STE 350
FRESNO CA
93710-7904
US

V. Phone/Fax

Practice location:
  • Phone: 559-367-6839
  • Fax:
Mailing address:
  • Phone: 559-367-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number22073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: