Kingston Wellness Retreat LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

KINGSTON WELLNESS RETREAT LLC

Practice address

45 E Howard St
Kingston, GA 30145-3003

Phone

(561) 797-3264

NPI assigned

Feb 21, 2025

Last updated

Nov 26, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Danielle Craig

Title

VP Facility Operations

Phone

(561) 797-3264

Specialties & licenses 4

Addresses

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1497551337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GOVERNORS TRCE STE 101",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 E HOWARD ST",
            "city": "KINGSTON",
            "state": "GA",
            "postal_code": "301453003",
            "telephone_number": "561-797-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTON WELLNESS RETREAT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-21",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "CRAIG",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "VP FACILITY OPERATIONS",
        "authorized_official_telephone_number": "561-797-3264"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://ats11270.kipuworks.com/users/sign_in",
            "affiliation": "N",
            "address_1": "45 E Howard St",
            "city": "Kingston",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301453003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracey Cooke
• Carole Elaine Gooch, APRN,BC
• Happy Hearts Pediatric Therapy LLC
• Hannah Joy Harrison, M.S., CF-SLP
• House Calls of NW Georgia, LLC
• Moore Surgical Assistant, LLC
• Emily Jane Self
• Jeffrrey Cornelius Shelley
• Mildred Gail Weedon
• Devan Wessel, BCBA

• Psychiatric Residential Treatment Facility in Kingston, GA
• Providers in Kingston, GA by specialty
• Psychiatric Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.