Healthcare Provider Details

I. General information

NPI: 1174452403
Provider Name (Legal Business Name): DIRTY TALK COUNSELING AND CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

IV. Provider business mailing address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

V. Phone/Fax

Practice location:
  • Phone: 937-441-0159
  • Fax:
Mailing address:
  • Phone: 937-441-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JERAD ANTHONY MINIC
Title or Position: OWNER
Credential: DSW, LISW-S
Phone: 937-441-0159