KELLY REBECCA PETACCIO MS LPC CPCS NPI 1669751160

NPI Information

NPI: 1669751160
Provider Name: KELLY REBECCA PETACCIO, MS LPC CPCS
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
130 GOVERNORS SQ STE B
PEACHTREE CITY, GA
ZIP 30269
Phone: (770) 519-2743
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Kelly Rebecca Petaccio, MS LPC CPCS is a mental health counselor in Peachtree City, GA. Kelly Rebecca Petaccio, MS LPC CPCS NPI is 1669751160. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

130 GOVERNORS SQ STE B
PEACHTREE CITY, GA
ZIP 30269-862
Phone: (770) 519-2743

The enumeration date for this NPI number is 8/15/2011 and was last updated on 1/27/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	LPC008109	GEORGIA	Yes
2	101YM0800X	Counselor	Mental Health			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1457876906	OTHER	GEORGIA	THE CENTER FOR LIVING BALANCE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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