Provider Demographics
NPI:1659003010
Name:PLOURD, ADIA VISOLELA (PSYD, LAC)
Entity Type:Individual
Prefix:DR
First Name:ADIA
Middle Name:VISOLELA
Last Name:PLOURD
Suffix:
Gender:F
Credentials:PSYD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1780
Mailing Address - Country:US
Mailing Address - Phone:602-391-6527
Mailing Address - Fax:
Practice Address - Street 1:7155 W CAMPO BELLO DR STE B110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8594
Practice Address - Country:US
Practice Address - Phone:623-218-6030
Practice Address - Fax:623-218-6230
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20991101YM0800X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling