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General NPI Number Information
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NPI Number | 1821514902
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Entity Type | Organization
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Legal Business Name | TAKE FLIGHT SERVICES, INC
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 841 PRUDENTIAL DR STE 1200
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8874
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Country | US
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Telephone | 866-585-1790
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Fax |
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Provider Business Mailing Address
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Address Line | 841 PRUDENTIAL DR. STE. 1200
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City | JACKSONVILLE
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State | FL
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Zip | 32207
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Country | US
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Telephone | 866-585-1790
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER CLINICAL/COUNSELOR
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Name | MS. WANDA RENFROW
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Credential | MSW
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Telephone | 404-630-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P006527
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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