Healthcare Provider Details

I. General information

NPI: 1619730082
Provider Name (Legal Business Name): HEALING THROUGH CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
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: 602-935-4084
  • Fax: 623-218-6230
Mailing address:
  • Phone: 602-935-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADIA VISOLELA PLOURD
Title or Position: OWNER
Credential: PSY, D
Phone: 602-935-4084