Petaccio, Kelly Rebecca
Petaccio, Kelly Rebecca is an sole proprietor health care provider with primary practice located at 130 Governors Sq Ste B , Peachtree City GA 30269-4862. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Petaccio, Kelly Rebecca can be contacted via phone (770) 519-2743.Contact Information
Primary practice address
130 Governors Sq Ste B
Peachtree City GA 30269-4862
Phone: (770) 519-2743
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | ||
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | LPC008109 | Georgia |
Profile Details
| NPI number | 1669751160 |
|---|---|
| LBN Legal business name | Petaccio, Kelly Rebecca |
| Credentials | MS LPC CPCS |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 15th, 2011 |
| Last updated | Jan 27th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669751160 | NPPES |
| Georgia | Other | 1457876906 | THE CENTER FOR LIVING BALANCE |
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