Mardrey Alicia Wade Kiles, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4255 Issued in TN

Practice address

5104 Stage Rd
Memphis, TN 38134-3164

Phone

(901) 646-1053

Fax

(901) 424-9078

NPI assigned

May 3, 2018

Last updated

Aug 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Headshop

  dba Mardrey Wade Kiles

  • Professional Counselor
  • Memphis, TN
  • NPI 1508643818
  NPD Authorized official

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1316436439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1788 CHESHUNT LN",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380163507",
            "telephone_number": "901-870-8682",
            "fax_number": "901-424-9078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5104 STAGE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381343164",
            "telephone_number": "901-646-1053",
            "fax_number": "901-424-9078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE KILES",
        "first_name": "MARDREY",
        "middle_name": "ALICIA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-03",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "4255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neha Arvind Vyas, R.PH
• W.W. Taylor, Jr, M.D., P.C.
• Dawn Medley Waddell, PHARMD
• Patience Jarrett Waddell, DNP
• Tempia Waddell, LPC-MHSP
• Wade-Hampton Counseling & Consulting, LLC
• Veronica Wade-Hampton, M.S., LPC-MHSP, NCC
• Deanie Eilee Wade-Smith, APN, NP-C
• Jennifer Jo Wade, D.D.S
• Jessica Wade, APRN

• Professional Counselor in Memphis, TN
• Providers in Memphis, TN by specialty
• Professional Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.