Provider Demographics
NPI:1659061547
Name:HOLDING SPACE INC.
Entity Type:Organization
Organization Name:HOLDING SPACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CST
Authorized Official - Phone:808-753-3329
Mailing Address - Street 1:51-015 LAU PL
Mailing Address - Street 2:
Mailing Address - City:KAAAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96730-9817
Mailing Address - Country:US
Mailing Address - Phone:808-753-3329
Mailing Address - Fax:
Practice Address - Street 1:203 KAPAA QUARRY PL
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-201-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)