Provider Demographics
NPI:1821336199
Name:WHOLAS, MARIKA SEMONE
Entity Type:Individual
Prefix:MISS
First Name:MARIKA
Middle Name:SEMONE
Last Name:WHOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 LYONS RD APT 101
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2815
Mailing Address - Country:US
Mailing Address - Phone:561-479-8930
Mailing Address - Fax:
Practice Address - Street 1:5500 LYONS RD APT 101
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2815
Practice Address - Country:US
Practice Address - Phone:561-479-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW421-557-88-718-0103K00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst