Healthcare Provider Details

I. General information

NPI: 1265976708
Provider Name (Legal Business Name): ROSHUNA BANKS-YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W HOWZE BEACH RD
SLIDELL LA
70458-8501
US

IV. Provider business mailing address

222 GREENCREST DR
SLIDELL LA
70458-5108
US

V. Phone/Fax

Practice location:
  • Phone: 985-285-4517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14152
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: