Organization
THE HEADSHOP
Active
Parent organization
THE HEADSHOP
Other names
Mardrey Wade Kiles, The HEADSHOP
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE HEADSHOP
Authorized official
MARDREY ALICIA WADE KILES LPC- MHSP (OWNER, CLINICAL DIRECTOR, THERAPIST)
(901) 870-8682
Entity
Organization
Contact information
Practice address
5104 STAGE RD, MEMPHIS, TN 38134-3164
(901) 870-8682
(901) 424-9078
Mailing address
1788 CHESHUNT LN, CORDOVA, TN 38016-3507
(901) 870-8682
(901) 424-9078
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
09/11/2023
Last updated
10/27/2025
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