Provider Demographics
NPI:1881995223
Name:CHARLESTON, ARCENIO
Entity type:Individual
Prefix:
First Name:ARCENIO
Middle Name:
Last Name:CHARLESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515-0709
Mailing Address - Country:US
Mailing Address - Phone:505-368-1506
Mailing Address - Fax:505-368-1462
Practice Address - Street 1:HIWAY 491 NORTH PINION STREET
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1830
Practice Address - Country:US
Practice Address - Phone:505-368-1438
Practice Address - Fax:505-368-1452
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor