Provider Demographics
NPI:1508470550
Name:TAKE FLIGHT COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:TAKE FLIGHT COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:MARRIA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-584-1494
Mailing Address - Street 1:8377 PALADIN SQ
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-5466
Mailing Address - Country:US
Mailing Address - Phone:772-584-1595
Mailing Address - Fax:
Practice Address - Street 1:8377 PALADIN SQ
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-5466
Practice Address - Country:US
Practice Address - Phone:772-202-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-06
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty