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General NPI Number Information
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NPI Number | 1295535128
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Entity Type | Organization
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Legal Business Name | SOLACE GROUP LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 6741 SEBASTOPOL AVE STE 160
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City | SEBASTOPOL
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State | CA
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Zip | 95472-3857
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Country | US
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Telephone | 707-861-1108
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Fax |
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Provider Business Mailing Address
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Address Line | 3171 ROSS RD UNIT 413
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City | GRATON
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State | CA
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Zip | 95444-5702
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Country | US
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Telephone | 407-369-0114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAREN PROSEN
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Credential | LMFT
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Telephone | 707-861-1108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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