Healthcare Provider Details

I. General information

NPI: 1679407506
Provider Name (Legal Business Name): KEVIN ACKERSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 SACRAMENTO ST
FAIR OAKS CA
95628-7526
US

IV. Provider business mailing address

4139 SHERA LN
CARMICHAEL CA
95608-1755
US

V. Phone/Fax

Practice location:
  • Phone: 916-877-6894
  • Fax: 916-581-8447
Mailing address:
  • Phone: 916-895-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: