Healthcare Provider Details

I. General information

NPI: 1275124042
Provider Name (Legal Business Name): ROSHUNDA LESHAY CORNISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 DALLAS DR STE C
BATON ROUGE LA
70806-1409
US

IV. Provider business mailing address

1676 DALLAS DR STE C
BATON ROUGE LA
70806-1409
US

V. Phone/Fax

Practice location:
  • Phone: 225-292-5151
  • Fax: 225-292-5152
Mailing address:
  • Phone: 225-292-5151
  • Fax: 225-292-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC-5217
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: