Healthcare Provider Details

I. General information

NPI: 1659003010
Provider Name (Legal Business Name): ADIA VISOLELA PLOURD PSYD, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 W CAMPO BELLO DR STE B110
GLENDALE AZ
85308-8594
US

IV. Provider business mailing address

318 S 116TH AVE
AVONDALE AZ
85323-1780
US

V. Phone/Fax

Practice location:
  • Phone: 623-218-6030
  • Fax: 623-218-6230
Mailing address:
  • Phone: 602-391-6527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-20991
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: