Provider Demographics
NPI:1659013290
Name:HOLDING SPACE COUNSELING, LLC
Entity Type:Organization
Organization Name:HOLDING SPACE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZI
Authorized Official - Middle Name:TRICHEL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PMH-C
Authorized Official - Phone:501-539-0695
Mailing Address - Street 1:2400 CRESTWOOD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7663
Mailing Address - Country:US
Mailing Address - Phone:501-409-6653
Mailing Address - Fax:
Practice Address - Street 1:2400 CRESTWOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7663
Practice Address - Country:US
Practice Address - Phone:501-409-6653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty