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KELLY REBECCA PETACCIO MS LPC CPCS
NPI 1669751160
Counselor - Mental Health in Peachtree City, GA

Active since August 15, 2011PECOS Enrolled
130 GOVERNORS SQ STE B, PEACHTREE CITY, GA 30269(770) 519-2743 Get Directions Write a Review

NPPES record last updated: January 27, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelly Rebecca Petaccio Ms Lpc Cpcs NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY REBECCA PETACCIO MS LPC CPCS (NPI 1669751160) is an individual mental health provider in Peachtree City, Georgia, licensed in Georgia (LPC008109) and active in the NPI registry since August 2011. She is enrolled in Medicare PECOS, maintains a secondary practice location in Langhorne, and is a graduate of Other (2007).

NPPES Registry Identity

NPI1669751160
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKELLY REBECCA PETACCIOCredential: MS LPC CPCS
Location Address130 GOVERNORS SQ STE BPeachtree City, GA 30269-4862
Mailing Address130 Governors Sq Ste BPeachtree City, GA 30269-4862 · (770) 519-2743
Phone(770) 519-2743
Sole ProprietorYes
Medical School CMSOtherGraduated 2007
Enumeration DateAugust 15, 2011
Last NPPES UpdateJanuary 27, 2020
✔ NPI 1669751160 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in GA · LPC008109
130 GOVERNORS SQ STE B, Peachtree City, GA 30269
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Other Names 1

Former Name (1)Kelly Rebecca Weister

Secondary Practice Location 1

Location 12005 Cabot Blvd WLanghorne, PA 19047-1885 · Phone (267) 587-2300

Other Identifiers 1

Other1457876906GA · The Center For Living Balance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Rebecca Petaccio Ms Lpc Cpcs is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4486121084
PECOS Enrollment IDI20260430002239
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THE CENTER FOR LIVING BALANCE, INC
Clinic/Center (Mental Health (Including Community Mental Health Center))
130 GOVERNORS SQ STE B
PEACHTREE CITY, GA 30269
Fayette County (770) 451-0404
AMY FOWLER JAYNES MS, LPC, NCC, CRC
Counselor (Professional)
130 GOVERNORS SQ STE B
PEACHTREE CITY, GA 30269
Fayette County (770) 451-0404
DEANA RILEY L.P.C., C.P.C.S.
Counselor (Professional)
130 GOVERNORS SQ STE B
PEACHTREE CITY, GA 30269
Fayette County (770) 713-8023

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Petaccio's NPI number?

The NPI number for Kelly Petaccio is 1669751160. It was assigned to this individual provider in the NPPES registry on August 15, 2011. The provider is also known as Kelly Rebecca Weister.

Where is Kelly Petaccio located?

Kelly Petaccio practices at 130 Governors Sq Ste B, Peachtree City, GA 30269. The listed phone number is (770) 519-2743.

What is Kelly Petaccio's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kelly Petaccio enrolled in Medicare?

Yes. Kelly Petaccio is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Petaccio was last updated on January 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.