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General NPI Number Information
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NPI Number | 1174452403
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Entity Type | Organization
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Legal Business Name | DIRTY TALK COUNSELING AND CONSULTATION LLC
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone | 937-441-0159
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Fax |
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Provider Business Mailing Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone | 937-441-0159
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERAD ANTHONY MINIC
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Credential | DSW, LISW-S
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Telephone | 937-441-0159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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