Healthcare Provider Details

I. General information

NPI: 1407762107
Provider Name (Legal Business Name): HOLDING SPACE CASE MANAGEMENT AND COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 WILDWOOD AVE
RIO DELL CA
95562-1539
US

IV. Provider business mailing address

PO BOX 586
EUREKA CA
95502-0586
US

V. Phone/Fax

Practice location:
  • Phone: 707-731-3282
  • Fax: 707-731-3282
Mailing address:
  • Phone: 707-731-3282
  • Fax: 707-731-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. DANETTE RENEE KELLERMAN
Title or Position: OWNER
Credential: KELLERMAN
Phone: 707-731-3282