| NPI | 1508643818 |
|---|---|
| Other Name | THE HEADSHOP |
| Doing Business As | MARDREY WADE KILES |
| Entity Type | Organization |
| Authorized Contact | MARDREY ALICIA WADE KILES Owner, Clinical Director, Therapist 901-870-8682 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2024-08-26 |