Healthcare Provider Details

I. General information

NPI: 1740692458
Provider Name (Legal Business Name): JESSICA ANTOINETTE PETERNELJ- MONEA M.A., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MARKET AVE N
CANTON OH
44702-1017
US

IV. Provider business mailing address

3445 S MAIN ST
COVENTRY TOWNSHIP OH
44319-3028
US

V. Phone/Fax

Practice location:
  • Phone: 330-479-1912
  • Fax:
Mailing address:
  • Phone: 330-644-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1600049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: