Provider Demographics
NPI:1821514902
Name:TAKE FLIGHT SERVICES, INC
Entity Type:Organization
Organization Name:TAKE FLIGHT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER CLINICAL/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENFROW
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:404-630-9660
Mailing Address - Street 1:841 PRUDENTIAL DR.
Mailing Address - Street 2:STE. 1200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:866-585-1790
Mailing Address - Fax:
Practice Address - Street 1:841 PRUDENTIAL DR STE 1200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8874
Practice Address - Country:US
Practice Address - Phone:866-585-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NCP0065271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty