Individual provider Active NPI

Jawan Angel Dickerson-Escobar, LMHC, NCC, CAP

  • Mental Health Counselor
  • Orlando, FL
National Provider Identifier
1366109936
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH28040 Issued in FL
Practice address
4150 Eastgate Dr Apt 5404
Orlando, FL 32839-5224
Phone
(407) 205-4397
NPI assigned
Nov 18, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 12299 SC
Mental Health Counselor 101YM0800X MH28040 FL Primary

Addresses

Primary practice location

4150 Eastgate Dr Apt 5404
Orlando, FL 32839-5224

Mailing address

4530 S Orange Blossom TRL
Orlando, FL 32839-1704
Phone (407) 205-4397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
IMH26967FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Solace & Sage Counseling & Consulting Services, LLC. Addiction (Substance Use Disorder) Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1366109936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 S ORANGE BLOSSOM TRL",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328391704",
            "telephone_number": "407-205-4397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 EASTGATE DR APT 5404",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328395224",
            "telephone_number": "407-205-4397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON-ESCOBAR",
        "first_name": "JAWAN",
        "middle_name": "ANGEL",
        "name_prefix": "Mr.",
        "credential": "LMHC, NCC, CAP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-18",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "12299",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH28040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.