Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kelly Rebecca Petaccio, MSLPCCPCS

Individual provider Mental Health Counselor · NPI 1669751160

Kelly Rebecca Petaccio, MSLPCCPCS is a Mental Health Counselor in Peachtree City, Georgia. Qualified in 2007, 19 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in Georgia.

Years since qualifying
19
Licensed in
GA
In the registry since
2011
Specialties on file
2
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Practice location Address checks out

130 Governors Sq Ste B
Peachtree City, GA 30269-4862
Phone: (770) 519-2743
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2005 Cabot Blvd W, Langhorne, PA 19047-1885 — (267) 587-2300

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence LPC008109 (GA)
Mental Health Counselor Taxonomy 101YM0800X

Record details

NPI number1669751160
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSLPCCPCS
Sole proprietorYes
NPI enumeratedAugust 15, 2011
Last updated in NPPESJanuary 27, 2020
Certification dateJanuary 27, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Peachtree City