=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407762107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLDING SPACE CASE MANAGEMENT AND COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2026
-----------------------------------------------------
Last Update Date | 08/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 WILDWOOD AVE
-----------------------------------------------------
City | RIO DELL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95562-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-731-3282
-----------------------------------------------------
Fax | 707-731-3282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 586
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95502-0586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-731-3282
-----------------------------------------------------
Fax | 707-731-3282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. DANETTE RENEE KELLERMAN
-----------------------------------------------------
Credential | KELLERMAN
-----------------------------------------------------
Telephone | 707-731-3282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------