# TAILORED ROOTS BEHAVIORAL HEALTH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568368470
- **Authorized official:** SHAQUANDA S GORDON PMHNP-BC (OWNER/MANAGING MEMBER)
- **Authorized official phone:** (470) 583-2403

## Contact information

- **Practice address:** 825 BELMAR PASS, FAIRBURN, GA 30213-4482
- **Practice address phone:** (470) 583-2403
- **Mailing address:** 825 BELMAR PASS, FAIRBURN, GA 30213-4482
- **Mailing address phone:** (470) 583-2403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |

## Other

- **Enumeration date:** 10/16/2026
- **Last updated:** 10/16/2026