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5104 Stage Rd Memphis TN 38134-3164 | |
| (901) 870-8682 | |
| (901) 424-9078 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 5104 Stage Rd, Memphis, Tennessee |
| Authorized Official Name and Position | Mardrey Alicia Wade Kiles (OWNER, CLINICAL DIRECTOR, THERAPIST) |
| Authorized Official Contact | 9018708682 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1788 Cheshunt Ln Cordova TN 38016-3507 Ph: (901) 870-8682 | 5104 Stage Rd Memphis TN 38134-3164 Ph: (901) 870-8682 |
| NPI Number | 1508643818 |
|---|---|
| Provider Enumeration Date | 09/11/2023 |
| Last Update Date | 08/26/2024 |
| Certification Date | 08/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508643818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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