The Headshop

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

THE HEADSHOP

Doing business as

Mardrey Wade Kiles

Practice address

5104 Stage Rd
Memphis, TN 38134-3164

Phone

(901) 870-8682

Fax

(901) 424-9078

NPI assigned

Sep 11, 2023

Last updated

Oct 27, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

THE HEADSHOPAs reported in NPPES

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

Authorized official

Name

Mardrey Alicia Wade Kiles, LPC- MHSPNPI 1316436439

Title

Owner, Clinical Director, Therapist

Phone

(901) 870-8682

Specialties & licenses 1

Addresses

Other names 2

• Mardrey Wade Kiles Doing business as
• The HEADSHOP Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mardrey Alicia Wade Kiles, LPC

  • Professional Counselor
  • Memphis, TN
  • NPI 1316436439
  NPD Authorized official

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

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761523200000",
    "number": "1508643818",
    "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": "901-870-8682",
            "fax_number": "901-424-9078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HEADSHOP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE HEADSHOP",
        "enumeration_date": "2023-09-11",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A",
        "authorized_official_last_name": "WADE KILES",
        "authorized_official_first_name": "MARDREY",
        "authorized_official_middle_name": "ALICIA",
        "authorized_official_title_or_position": "OWNER, CLINICAL DIRECTOR, THERAPIST",
        "authorized_official_telephone_number": "901-870-8682",
        "authorized_official_credential": "LPC- MHSP"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mardrey Wade Kiles",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The HEADSHOP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• 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 Oct 27, 2025; 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.