Provider Demographics
NPI:1114759222
Name:HOLDING SPACE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:HOLDING SPACE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LANTZ
Authorized Official - Last Name:ROHLFS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-C, IMH, MED
Authorized Official - Phone:248-470-6149
Mailing Address - Street 1:1481 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2051
Mailing Address - Country:US
Mailing Address - Phone:248-470-6149
Mailing Address - Fax:
Practice Address - Street 1:1481 PALMER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2051
Practice Address - Country:US
Practice Address - Phone:248-470-6149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty