Provider Demographics
NPI:1295535128
Name:SOLACE GROUP LLC
Entity type:Organization
Organization Name:SOLACE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-861-1108
Mailing Address - Street 1:3171 ROSS RD UNIT 413
Mailing Address - Street 2:
Mailing Address - City:GRATON
Mailing Address - State:CA
Mailing Address - Zip Code:95444-5702
Mailing Address - Country:US
Mailing Address - Phone:407-369-0114
Mailing Address - Fax:
Practice Address - Street 1:6741 SEBASTOPOL AVE STE 160
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3857
Practice Address - Country:US
Practice Address - Phone:707-861-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)