Provider Demographics
NPI:1417328238
Name:CHARNA, JENNIFER (LPCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHARNA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 FATHER CARUSO DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2093
Mailing Address - Country:US
Mailing Address - Phone:216-403-9723
Mailing Address - Fax:
Practice Address - Street 1:8251 MAYFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2567
Practice Address - Country:US
Practice Address - Phone:440-688-4308
Practice Address - Fax:833-206-5014
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.162156101YA0400X
OHC.1901886101YP2500X
OH2102419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2374229Medicaid