Healthcare Provider Details

I. General information

NPI: 1053027995
Provider Name (Legal Business Name): MR. CHARLES EARL ABERNATHYBETTIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 COUNTY HOSPITAL RD STE 109
QUINCY CA
95971-9173
US

IV. Provider business mailing address

270 COUNTY HOSPITAL RD STE 109
QUINCY CA
95971-9173
US

V. Phone/Fax

Practice location:
  • Phone: 530-283-6307
  • Fax: 530-283-6045
Mailing address:
  • Phone: 530-283-6307
  • Fax: 530-283-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: