Provider Demographics
NPI:1548574460
Name:WHOLUBA, BENETTA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENETTA
Middle Name:H
Last Name:WHOLUBA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 LIBRA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-6511
Mailing Address - Country:US
Mailing Address - Phone:407-823-2811
Mailing Address - Fax:407-823-5415
Practice Address - Street 1:4090 LIBRA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-6511
Practice Address - Country:US
Practice Address - Phone:407-823-2811
Practice Address - Fax:407-823-5415
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLPY9802103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor