# KINGSTON WELLNESS RETREAT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497551337
- **Authorized official:** DANIELLE CRAIG (VP FACILITY OPERATIONS)
- **Authorized official phone:** (561) 797-3264

## Contact information

- **Practice address:** 45 E HOWARD ST, KINGSTON, GA 30145-3003
- **Practice address phone:** (561) 797-3264
- **Mailing address:** 100 GOVERNORS TRCE STE 101, PEACHTREE CITY, GA 30269-4853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 02/21/2025
- **Last updated:** 11/26/2025