Provider Demographics
NPI:1558103457
Name:HOLDING SPACE THERAPEUTIC COLLECTIVE, PLLC
Entity type:Organization
Organization Name:HOLDING SPACE THERAPEUTIC COLLECTIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:248-617-1001
Mailing Address - Street 1:23131 MICHIGAN AVE # 1169
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2020
Mailing Address - Country:US
Mailing Address - Phone:248-617-1001
Mailing Address - Fax:
Practice Address - Street 1:3200 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120
Practice Address - Country:US
Practice Address - Phone:248-617-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty