Healthcare Provider Details

I. General information

NPI: 1568386381
Provider Name (Legal Business Name): ACADEMICS 4 ATHLETES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 DEL PASO BLVD
SACRAMENTO CA
95815-2352
US

IV. Provider business mailing address

PO BOX 340511
SACRAMENTO CA
95834-0511
US

V. Phone/Fax

Practice location:
  • Phone: 916-802-6456
  • Fax: 888-588-1354
Mailing address:
  • Phone: 916-821-3423
  • Fax: 888-588-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PRENTICE DEONARD WILSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-821-3423