Healthcare Provider Details

I. General information

NPI: 1679428478
Provider Name (Legal Business Name): HOLDING SPACE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 AVIS DR
UPPER MARLBORO MD
20774-2286
US

IV. Provider business mailing address

PO BOX 1481
UPPER MARLBORO MD
20773-1481
US

V. Phone/Fax

Practice location:
  • Phone: 202-247-0279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANTAE J ELLIOTT
Title or Position: CO-OWNER
Credential: LCPC
Phone: 202-247-0279