Healthcare Provider Details

I. General information

NPI: 1053241430
Provider Name (Legal Business Name): KATIE LYNN ANDREACCHIO M.S., P-LPC, BC-TMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 HIGHWAY 39 APT 21A
MERIDIAN MS
39305-9658
US

IV. Provider business mailing address

8221 HIGHWAY 39 APT 12A
MERIDIAN MS
39305-9607
US

V. Phone/Fax

Practice location:
  • Phone: 601-851-6822
  • Fax:
Mailing address:
  • Phone: 601-851-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1398
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: