=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609748763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLDING SPACE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2025
-----------------------------------------------------
Last Update Date | 09/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12313 SURREY CIRCLE DR
-----------------------------------------------------
City | FT WASHINGTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20744-6229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-538-3973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12313 SURREY CIRCLE DR
-----------------------------------------------------
City | FT WASHINGTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20744-6229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | SHERYL DANIEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-538-3973
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------