Healthcare Provider Details

I. General information

NPI: 1700708914
Provider Name (Legal Business Name): SOLACE & SAGE COUNSELING & CONSULTING SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 EASTGATE DR APT 5404
ORLANDO FL
32839-5224
US

IV. Provider business mailing address

4150 EASTGATE DR APT 5404
ORLANDO FL
32839-5224
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-4397
  • Fax:
Mailing address:
  • Phone: 407-205-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JAWAN ANGEL DICKERSON-ESCOBAR
Title or Position: OWNER/CLINICAL THERAPIST
Credential: LMHC, LPC, NCC, CAP
Phone: 407-205-4397