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General NPI Number Information
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NPI Number | 1659003010
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Entity Type | Individual
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Provider Name | ADIA VISOLELA PLOURD PSYD, LAC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 7155 W CAMPO BELLO DR STE B110
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City | GLENDALE
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State | AZ
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Zip | 85308-8594
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Country | US
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Telephone | 623-218-6030
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Fax | 623-218-6230
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Provider Business Mailing Address
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Address Line | 318 S 116TH AVE
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City | AVONDALE
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State | AZ
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Zip | 85323-1780
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Country | US
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Telephone | 602-391-6527
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-20991
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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